Rym El Khoury1,2, Christopher Kabir3, Vijay K Maker1,2, Mihaela Banulescu2, Margaret Wasserman2, Ajay V Maker4,5. 1. Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, 835 S. Wolcott St. MC790, Chicago, IL, 60612, USA. 2. Department of Surgery, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA. 3. Advocate Research Institute, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA. 4. Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, 835 S. Wolcott St. MC790, Chicago, IL, 60612, USA. amaker@uic.edu. 5. Department of Surgery, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA. amaker@uic.edu.
Abstract
BACKGROUND: A subset of intraductal papillary mucinous neoplasms (IPMNs) will progress to invasive adenocarcinoma, however identifying invasive from non-invasive disease preoperatively remains challenging. The rate of malignancy in resected IPMNs in the US remains unclear. OBJECTIVE: We aimed to determine the rate of malignancy and factors associated with high-risk pathology in resected IPMNs. METHODS: The most recent annual cohort of patients undergoing pancreatectomy included in the American College of Surgeons National Surgical Quality Improvement Program were assessed, and contributions of demographics, preoperative laboratory values, and outcome data to level of IPMN dysplasia were analyzed. The main outcomes were incidence of invasive carcinoma or high-grade dysplasia. RESULTS: Of 5025 pancreatectomies in 1 year, 478 patients underwent pancreatectomy for IPMN. Invasive carcinoma/high-grade dysplasia was identified in 23% of resected lesions, and there was no difference in patient characteristics or type of resection performed in patients with invasive versus non-invasive pathology. Patients with invasive IPMNs presented significantly more often with high liver function tests, >10% weight loss, clinical jaundice and stent placement, and were more likely to undergo an open operation (p = 0.03). There were no differences in perioperative outcomes. Adjusted logistic regression identified an association between invasive disease and non-soft pancreatic gland texture (odds ratio 0.19, 95% confidence interval 0.05-0.68, p < 0.01). CONCLUSIONS: Approximately 10% of all pancreatectomies in the US are for IPMNs. In these patients, treated after the revised international consensus guidelines, only 23% of IPMNs contained invasive or high-grade histology. Resections carried similar morbidity regardless of pathology. Improved biomarkers are needed to aid in surgical selection.
BACKGROUND: A subset of intraductal papillary mucinous neoplasms (IPMNs) will progress to invasive adenocarcinoma, however identifying invasive from non-invasive disease preoperatively remains challenging. The rate of malignancy in resected IPMNs in the US remains unclear. OBJECTIVE: We aimed to determine the rate of malignancy and factors associated with high-risk pathology in resected IPMNs. METHODS: The most recent annual cohort of patients undergoing pancreatectomy included in the American College of Surgeons National Surgical Quality Improvement Program were assessed, and contributions of demographics, preoperative laboratory values, and outcome data to level of IPMN dysplasia were analyzed. The main outcomes were incidence of invasive carcinoma or high-grade dysplasia. RESULTS: Of 5025 pancreatectomies in 1 year, 478 patients underwent pancreatectomy for IPMN. Invasive carcinoma/high-grade dysplasia was identified in 23% of resected lesions, and there was no difference in patient characteristics or type of resection performed in patients with invasive versus non-invasive pathology. Patients with invasive IPMNs presented significantly more often with high liver function tests, >10% weight loss, clinical jaundice and stent placement, and were more likely to undergo an open operation (p = 0.03). There were no differences in perioperative outcomes. Adjusted logistic regression identified an association between invasive disease and non-soft pancreatic gland texture (odds ratio 0.19, 95% confidence interval 0.05-0.68, p < 0.01). CONCLUSIONS: Approximately 10% of all pancreatectomies in the US are for IPMNs. In these patients, treated after the revised international consensus guidelines, only 23% of IPMNs contained invasive or high-grade histology. Resections carried similar morbidity regardless of pathology. Improved biomarkers are needed to aid in surgical selection.
Authors: Ajay V Maker; Vincent Hu; Shrihari S Kadkol; Lenny Hong; William Brugge; Jordan Winter; Charles J Yeo; Thilo Hackert; Markus Büchler; Rita T Lawlor; Roberto Salvia; Aldo Scarpa; Claudio Bassi; Stefan Green Journal: J Am Coll Surg Date: 2019-02-19 Impact factor: 6.113
Authors: Giovanni Marchegiani; Tommaso Pollini; Stefano Andrianello; Giorgia Tomasoni; Marco Biancotto; Ammar A Javed; Benedict Kinny-Köster; Neda Amini; Youngmin Han; Hongbeom Kim; Wooil Kwon; Michael Kim; Giampaolo Perri; Jin He; Claudio Bassi; Brian K Goh; Matthew H Katz; Jin-Young Jang; Christopher Wolfgang; Roberto Salvia Journal: JAMA Surg Date: 2021-07-01 Impact factor: 14.766
Authors: Johannes F Fahrmann; C Max Schmidt; Xiangying Mao; Ehsan Irajizad; Maureen Loftus; Jinming Zhang; Nikul Patel; Jody Vykoukal; Jennifer B Dennison; James P Long; Kim-Anh Do; Jianjun Zhang; John A Chabot; Michael D Kluger; Fay Kastrinos; Lauren Brais; Ana Babic; Kunal Jajoo; Linda S Lee; Thomas E Clancy; Kimmie Ng; Andrea Bullock; Jeanine Genkinger; Michele T Yip-Schneider; Anirban Maitra; Brian M Wolpin; Samir Hanash Journal: Gastroenterology Date: 2020-12-14 Impact factor: 22.682