Lianne Scholten1, Nadine C M van Huijgevoort2, Marco J Bruno3, Carlos Fernandez-Del Castillo4, Sohei Satoi5, Alain Sauvanet6, Christopher Wolfgang7, Paul Fockens2, Suresh T Chari8, Marco Del Chiaro9, Jeanin E van Hooft2, Marc G Besselink10. 1. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center Amsterdam, the Netherlands. 2. Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Academic Medical Center Amsterdam, the Netherlands. 3. Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, the Netherlands. 4. Department of Surgery, Massachusetts General Hospital, Boston, MA. 5. Department of Surgery, Kansai Medical University, Hirakata, Japan. 6. Department of Surgery, Beaujon Hospital, Clichy, France. 7. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 8. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN. 9. Division of Surgery, Departments of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute at Karolinska University Hospital, Stockholm, Sweden. 10. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center Amsterdam, the Netherlands. Electronic address: m.g.besselink@amc.nl.
Abstract
BACKGROUND: The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%-60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future studies and help to prepare for a single international set of guidelines. METHODS: An online survey including case vignettes was sent to 221 international experts who had published on main duct/mixed type intraductal papillary mucinous neoplasm in the previous decade and to all surgeon and gastroenterologist members of the pancreatic cyst guideline committees of the European Study Group and the International Association of Pancreatology. RESULTS: Overall, 97 experts (67 surgeons, 30 gastroenterologists) from 19 countries replied (44% response rate). Most (93%) worked in an academic hospital, with a median of 15 years' experience with intraductal papillary mucinous neoplasm treatment. In main duct/mixed type intraductal papillary mucinous neoplasm patients with pancreatic duct dilation (>5 mm) in the entire pancreas, 41% (n = 37) advised nonoperative surveillance every 3-6 months, whereas 59% (n = 54) advised operative intervention. Of those who advised operative intervention, 46% (n = 25) would perform a total pancreatectomy and 31% (n = 17) pancreatoduodenectomy with follow-up. No structural differences in advice were seen between surgeons and gastroenterologists, between continents where the respondents lived, and based on years of experience. CONCLUSION: This international survey identified a clinically relevant lack of consensus in the treatment strategy in main duct/mixed type intraductal papillary mucinous neoplasm among experts. Studies with long-term follow-up including quality of life after partial and total pancreatectomy for main duct/mixed type intraductal papillary mucinous neoplasm are required.
BACKGROUND: The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%-60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future studies and help to prepare for a single international set of guidelines. METHODS: An online survey including case vignettes was sent to 221 international experts who had published on main duct/mixed type intraductal papillary mucinous neoplasm in the previous decade and to all surgeon and gastroenterologist members of the pancreatic cyst guideline committees of the European Study Group and the International Association of Pancreatology. RESULTS: Overall, 97 experts (67 surgeons, 30 gastroenterologists) from 19 countries replied (44% response rate). Most (93%) worked in an academic hospital, with a median of 15 years' experience with intraductal papillary mucinous neoplasm treatment. In main duct/mixed type intraductal papillary mucinous neoplasmpatients with pancreatic duct dilation (>5 mm) in the entire pancreas, 41% (n = 37) advised nonoperative surveillance every 3-6 months, whereas 59% (n = 54) advised operative intervention. Of those who advised operative intervention, 46% (n = 25) would perform a total pancreatectomy and 31% (n = 17) pancreatoduodenectomy with follow-up. No structural differences in advice were seen between surgeons and gastroenterologists, between continents where the respondents lived, and based on years of experience. CONCLUSION: This international survey identified a clinically relevant lack of consensus in the treatment strategy in main duct/mixed type intraductal papillary mucinous neoplasm among experts. Studies with long-term follow-up including quality of life after partial and total pancreatectomy for main duct/mixed type intraductal papillary mucinous neoplasm are required.
Authors: Alex B Blair; Ross M Beckman; Joseph R Habib; James F Griffin; Kelly Lafaro; Richard A Burkhart; William Burns; Matthew J Weiss; John L Cameron; Christopher L Wolfgang; Jin He Journal: HPB (Oxford) Date: 2021-09-23 Impact factor: 3.842
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Authors: Lianne Scholten; Anouk Ej Latenstein; Cora M Aalfs; Marco J Bruno; Olivier R Busch; Bert A Bonsing; Bas Groot Koerkamp; I Quintus Molenaar; Dirk T Ubbink; Jeanin E van Hooft; Paul Fockens; Jolanda Glas; J Hans DeVries; Marc G Besselink Journal: United European Gastroenterol J Date: 2020-07-23 Impact factor: 4.623
Authors: L Scholten; T F Stoop; M Del Chiaro; O R Busch; C van Eijck; I Q Molenaar; J H de Vries; M G Besselink Journal: Br J Surg Date: 2019-09-10 Impact factor: 6.939