Validation of Indications for Surgery of European Evidence-Based Guidelines for Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms

• Published in: Journal of gastrointestinal surgery Vol. 24; no. 11; pp. 2536 - 2543
• Main Authors: Jan, I-Shiow, Chang, Ming-Chu, Yang, Ching-Yao, Tien, Yu-Wen, Jeng, Yung-Ming, Wu, Chih-Horng, Chen, Bang-Bin, Chang, Yu-Ting
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2020; Springer Nature B.V
• Subjects: Adenocarcinoma, Mucinous - surgery; Carcinoma, Pancreatic Ductal - surgery; Gastroenterology; Humans; Medicine; Medicine & Public Health; Original Article; Pancreatic cancer; Pancreatic Intraductal Neoplasms - surgery; Pancreatic Neoplasms - surgery; Retrospective Studies; Surgery; Taiwan; Tumors; Taiwan; Intraductal papillary mucinous neoplasms (IPMNs); New-onset diabetes mellitus (DM); European evidence-based guidelines
• ISSN: 1091-255X; 1873-4626; 1873-4626
• DOI: 10.1007/s11605-019-04420-9

Background Which patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical intervention remains a controversial issue. The aim of this retrospective study was to validate the new European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) for the management of IPMNs. Methods One hundred fifty-eight patients with resected IPMNs at National Taiwan University Hospital between January 1994 and December 2016 were enrolled. Clinical information, including new-onset diabetes mellitus (DM) and preoperative CA 19-9 levels, were collected. All patients were stratified into three groups—absolute, relative indications, and conservative approach—according to EEBGPCN. The performance characteristics of EEBGPCN for high-grade dysplasia (HGD)/invasive carcinoma (IC) of IPMNs were calculated. Results One hundred seven (67.7%) patients with low-grade dysplasia and 51 patients with HGD/IC, including 10 HGD and 41 IC, were analyzed. The missed rate for HGD/IC by EEBGPCN was 1.9% (3/158). The sensitivity, specificity, positive and negative predictive values, and accuracy of the absolute or relative indications for resecting IPMN according to EEBGPCN were 94.1%, 28.0%, 38.4%, 90.9%, and 49.4%. Jaundice, enhancing mural nodule < 5 mm, cyst diameter > 40 mm, increased levels of serum CA 19-9, new-onset DM, and main pancreatic duct dilation were associated with HGD/IC. Conclusions The missed rate for HGD/IC is low by EEBGPCN. Increased serum CA 19-9 and new-onset DM in EEBGPCN were verified as the indications for the surgical resection of IPMNs.