Gregory C Wilson1, Shishir K Maithel2, David Bentrem3, Daniel E Abbott4, Sharon Weber4, Clifford Cho4, Robert C G Martin5, Charles R Scoggins5, Hong Jin Kim6, Nipun B Merchant7, David A Kooby2, Michael J Edwards1, Syed A Ahmad8. 1. Division of Surgical Oncology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH. 2. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA. 3. Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL. 4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. 5. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY. 6. Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC. 7. Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL. 8. Division of Surgical Oncology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH. Electronic address: ahmadsy@uc.edu.
Abstract
BACKGROUND: Controversy persists regarding the management of patients with intraductal papillary mucinous neoplasms (IPMN). International consensus guidelines stratify patients into high-risk, worrisome, and low risk categories. STUDY DESIGN: The medical records of 7 institutions were reviewed for patients who underwent surgical management of IPMN between 2000 and 2015. RESULTS: There were 324 patients included in the analysis; 60.4% of patients had main-duct/mixed type, and 39.7% had branch-duct IPMN. The median cyst size was 2.65 cm, invasive cancer (IC) or high-grade dysplasia (HGD) was present in 42% (n = 136); 68.9% of patients with high-risk, 40.0% of patients with worrisome, and 24.6% of patients with low risk features exhibited HGD/IC. Multivariate analysis demonstrated that only 1 of 3 high-risk features and 2 of 7 worrisome features predicted the presence of HGD/IC. Positive predictive values for HGD/ IC in patients with obstructive jaundice and lymphadenopathy were 0.83 (95% CI 0.65 to 0.94) and 0.69 (95% CI 0.39 to 0.91), respectively. In the absence of high-risk features, HGD/IC was still present in 57.4% of patients with 2 or more worrisome features. Regression analysis demonstrated that each additional worrisome factor present was additive in predicting HGD/IC in a linear fashion (odds ratio 1.39; 95% CI 1.08 to 1.80; p < 0.01). CONCLUSIONS: These data demonstrate that the current consensus guidelines for surgical resection of IPMN may not adequately stratify and identify patients at risk for having HGD or invasive cancer. Patients with multiple worrisome features, in the absence of high-risk factors, should be considered for resection.
BACKGROUND: Controversy persists regarding the management of patients with intraductal papillary mucinous neoplasms (IPMN). International consensus guidelines stratify patients into high-risk, worrisome, and low risk categories. STUDY DESIGN: The medical records of 7 institutions were reviewed for patients who underwent surgical management of IPMN between 2000 and 2015. RESULTS: There were 324 patients included in the analysis; 60.4% of patients had main-duct/mixed type, and 39.7% had branch-duct IPMN. The median cyst size was 2.65 cm, invasive cancer (IC) or high-grade dysplasia (HGD) was present in 42% (n = 136); 68.9% of patients with high-risk, 40.0% of patients with worrisome, and 24.6% of patients with low risk features exhibited HGD/IC. Multivariate analysis demonstrated that only 1 of 3 high-risk features and 2 of 7 worrisome features predicted the presence of HGD/IC. Positive predictive values for HGD/ IC in patients with obstructive jaundice and lymphadenopathy were 0.83 (95% CI 0.65 to 0.94) and 0.69 (95% CI 0.39 to 0.91), respectively. In the absence of high-risk features, HGD/IC was still present in 57.4% of patients with 2 or more worrisome features. Regression analysis demonstrated that each additional worrisome factor present was additive in predicting HGD/IC in a linear fashion (odds ratio 1.39; 95% CI 1.08 to 1.80; p < 0.01). CONCLUSIONS: These data demonstrate that the current consensus guidelines for surgical resection of IPMN may not adequately stratify and identify patients at risk for having HGD or invasive cancer. Patients with multiple worrisome features, in the absence of high-risk factors, should be considered for resection.
Authors: Zachary E Stiles; Sheema Khan; Kurt T Patton; Meena Jaggi; Stephen W Behrman; Subhash C Chauhan Journal: HPB (Oxford) Date: 2018-08-14 Impact factor: 3.647
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Authors: Alessandra Pulvirenti; Georgios A Margonis; Vicente Morales-Oyarvide; Caitlin A McIntyre; Sharon A Lawrence; Debra A Goldman; Mithat Gonen; Matthew J Weiss; Cristina R Ferrone; Jin He; Murray F Brennan; John L Cameron; Keith D Lillemoe; T Peter Kingham; Vinod Balachandran; Motaz Qadan; Michael I D'Angelica; William R Jarnagin; Christopher L Wolfgang; Carlos Fernández-Del Castillo; Peter J Allen Journal: Ann Surg Date: 2021-12-01 Impact factor: 13.787