OBJECTIVE: To evaluate the influence of consensus guidelines on the management of intraductal papillary mucinous neoplasms (IPMN) and the subsequent changes in pathologic outcomes. BACKGROUND: Over time, multiple guidelines have been developed to identify high-risk IPMN. We hypothesized that the development and implementation of guidelines should have increased the percentage of resected IPMN with high-risk disease. METHODS: Memorial Sloan-Kettering (MSK), Johns Hopkins (JH), and Massachusetts General Hospital (MGH) databases were queried for resected IPMN (2000-2015). Patients were categorized into main-duct (MD-IPMN) versus branch-duct (BD-IPMN). Guideline-specific radiographic/endoscopic features were recorded. High-risk disease was defined as high-grade dysplasia/carcinoma. Fisher's exact test was used to detect differences between institutions. Logistic regression evaluated differences between time-points [preguidelines (pre-GL, before 2006), Sendai (SCG, 2006-2012), Fukuoka (FCG, after 2012)]. RESULTS: The study included 1210 patients. The percentage of BD-IPMN with ≥1 high-risk radiographic feature differed between centers (MSK 69%, JH 60%, MGH 45%; P < 0.001). In MD-IPMN cohort, the presence of radiographic features such as solid component and main pancreatic duct diameter ≥10 mm also differed (solid component: MSK 38%, JH 30%, MGH 18%; P < 0.001; duct ≥10 mm: MSK 49%, JH 32%, MGH 44%; P < 0.001). The percentage of high-risk disease on pathology, however, was similar between institutions (BD-IPMN: P = 0.36, MD-IPMN: P = 0.48). During the study period, the percentage of BD-IPMN resected with ≥1 high-risk feature increased (52% pre-GL vs 67% FCG; P = 0.005), whereas the percentage of high-risk disease decreased (pre-GL vs FCG: 30% vs 20%). For MD-IPMN, there was not a clear trend towards guideline adherence, and the rate of high-risk disease was similar over the time (pre-GL vs FCG: 69% vs 67%; P = 0.63). CONCLUSION: Surgical management of IPMN based on radiographic criteria is variable between institutions, with similar percentages of high-risk disease. Over the 15-year study period, the rate of BD-IPMN resected with high-risk radiographic features increased; however, the rate of high-risk disease decreased. Better predictors are needed.
OBJECTIVE: To evaluate the influence of consensus guidelines on the management of intraductal papillary mucinous neoplasms (IPMN) and the subsequent changes in pathologic outcomes. BACKGROUND: Over time, multiple guidelines have been developed to identify high-risk IPMN. We hypothesized that the development and implementation of guidelines should have increased the percentage of resected IPMN with high-risk disease. METHODS: Memorial Sloan-Kettering (MSK), Johns Hopkins (JH), and Massachusetts General Hospital (MGH) databases were queried for resected IPMN (2000-2015). Patients were categorized into main-duct (MD-IPMN) versus branch-duct (BD-IPMN). Guideline-specific radiographic/endoscopic features were recorded. High-risk disease was defined as high-grade dysplasia/carcinoma. Fisher's exact test was used to detect differences between institutions. Logistic regression evaluated differences between time-points [preguidelines (pre-GL, before 2006), Sendai (SCG, 2006-2012), Fukuoka (FCG, after 2012)]. RESULTS: The study included 1210 patients. The percentage of BD-IPMN with ≥1 high-risk radiographic feature differed between centers (MSK 69%, JH 60%, MGH 45%; P < 0.001). In MD-IPMN cohort, the presence of radiographic features such as solid component and main pancreatic duct diameter ≥10 mm also differed (solid component: MSK 38%, JH 30%, MGH 18%; P < 0.001; duct ≥10 mm: MSK 49%, JH 32%, MGH 44%; P < 0.001). The percentage of high-risk disease on pathology, however, was similar between institutions (BD-IPMN: P = 0.36, MD-IPMN: P = 0.48). During the study period, the percentage of BD-IPMN resected with ≥1 high-risk feature increased (52% pre-GL vs 67% FCG; P = 0.005), whereas the percentage of high-risk disease decreased (pre-GL vs FCG: 30% vs 20%). For MD-IPMN, there was not a clear trend towards guideline adherence, and the rate of high-risk disease was similar over the time (pre-GL vs FCG: 69% vs 67%; P = 0.63). CONCLUSION: Surgical management of IPMN based on radiographic criteria is variable between institutions, with similar percentages of high-risk disease. Over the 15-year study period, the rate of BD-IPMN resected with high-risk radiographic features increased; however, the rate of high-risk disease decreased. Better predictors are needed.
Authors: Gregory C Wilson; Shishir K Maithel; David Bentrem; Daniel E Abbott; Sharon Weber; Clifford Cho; Robert C G Martin; Charles R Scoggins; Hong Jin Kim; Nipun B Merchant; David A Kooby; Michael J Edwards; Syed A Ahmad Journal: J Am Coll Surg Date: 2017-01-11 Impact factor: 6.113
Authors: Brian K P Goh; Zhimin Lin; Damien M Y Tan; Choon-Hua Thng; Christopher J L Khor; Tony K H Lim; London L P J Ooi; Alexander Y F Chung Journal: Surgery Date: 2015-05-29 Impact factor: 3.982
Authors: M R Barron; A M Roch; J A Waters; J A Parikh; J M DeWitt; M A Al-Haddad; E P Ceppa; M G House; N J Zyromski; A Nakeeb; H A Pitt; C Max Schmidt Journal: J Gastrointest Surg Date: 2014-01-09 Impact factor: 3.452
Authors: Peter J Allen; Michael D'Angelica; Mithat Gonen; David P Jaques; Daniel G Coit; William R Jarnagin; Ronald DeMatteo; Yuman Fong; Leslie H Blumgart; Murray F Brennan Journal: Ann Surg Date: 2006-10 Impact factor: 12.969
Authors: Sébastien Gaujoux; Murray F Brennan; Mithat Gonen; Michael I D'Angelica; Ronald DeMatteo; Yuman Fong; Mark Schattner; Christopher DiMaio; Maria Janakos; William R Jarnagin; Peter J Allen Journal: J Am Coll Surg Date: 2011-04 Impact factor: 6.113
Authors: Simeon Springer; Yuxuan Wang; Marco Dal Molin; David L Masica; Yuchen Jiao; Isaac Kinde; Amanda Blackford; Siva P Raman; Christopher L Wolfgang; Tyler Tomita; Noushin Niknafs; Christopher Douville; Janine Ptak; Lisa Dobbyn; Peter J Allen; David S Klimstra; Mark A Schattner; C Max Schmidt; Michele Yip-Schneider; Oscar W Cummings; Randall E Brand; Herbert J Zeh; Aatur D Singhi; Aldo Scarpa; Roberto Salvia; Giuseppe Malleo; Giuseppe Zamboni; Massimo Falconi; Jin-Young Jang; Sun-Whe Kim; Wooil Kwon; Seung-Mo Hong; Ki-Byung Song; Song Cheol Kim; Niall Swan; Jean Murphy; Justin Geoghegan; William Brugge; Carlos Fernandez-Del Castillo; Mari Mino-Kenudson; Richard Schulick; Barish H Edil; Volkan Adsay; Jorge Paulino; Jeanin van Hooft; Shinichi Yachida; Satoshi Nara; Nobuyoshi Hiraoka; Kenji Yamao; Susuma Hijioka; Schalk van der Merwe; Michael Goggins; Marcia Irene Canto; Nita Ahuja; Kenzo Hirose; Martin Makary; Matthew J Weiss; John Cameron; Meredith Pittman; James R Eshleman; Luis A Diaz; Nickolas Papadopoulos; Kenneth W Kinzler; Rachel Karchin; Ralph H Hruban; Bert Vogelstein; Anne Marie Lennon Journal: Gastroenterology Date: 2015-08-04 Impact factor: 22.682
Authors: Peter J Allen; David P Jaques; Michael D'Angelica; Wilbur B Bowne; Kevin C Conlon; Murray F Brennan Journal: J Gastrointest Surg Date: 2003-12 Impact factor: 3.452
Authors: Mario Pelaez-Luna; Suresh T Chari; Thomas C Smyrk; Naoki Takahashi; Jonathan E Clain; Michael J Levy; Randall K Pearson; Bret T Petersen; Mark D Topazian; Santhi S Vege; Michael Kendrick; Michael B Farnell Journal: Am J Gastroenterol Date: 2007-08 Impact factor: 10.864
Authors: Kate A Harrington; Travis L Williams; Sharon A Lawrence; Jayasree Chakraborty; Mohammad A Al Efishat; Marc A Attiyeh; Gokce Askan; Yuting Chou; Alessandra Pulvirenti; Caitlin A McIntyre; Mithat Gonen; Olca Basturk; Vinod P Balachandran; T Peter Kingham; Michael I D'Angelica; William R Jarnagin; Jeffrey A Drebin; Richard K Do; Peter J Allen; Amber L Simpson Journal: J Med Imaging (Bellingham) Date: 2020-06-25
Authors: Ho Seung Kim; Jong Min Lee; Han Sang Kim; Seung Yoon Yang; Yoon Dae Han; Min Soo Cho; Hyuk Hur; Byung Soh Min; Kang Young Lee; Nam Kyu Kim Journal: Ann Surg Oncol Date: 2020-08-18 Impact factor: 5.344