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

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

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.

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References

  1. Bassi C, Sarr MG, Lillemoe KD, Reber HA. Natural History of Intraductal Papillary Mucinous Neoplasms (IPMN): Current Evidence and Implications for Management. J Gastrointest Surg. 2008;12(4):645-50. https://doi.org/10.1007/s11605-007-0447-x.

    Article  Google Scholar 

  2. Xu MM, Yin S, Siddiqui AA, Salem RR, Schrope B, Sethi A et al. Comparison of the diagnostic accuracy of three current guidelines for the evaluation of asymptomatic pancreatic cystic neoplasms. Medicine (Baltimore). 2017;96(35):e7900. https://doi.org/10.1097/md.0000000000007900.

    Article  PubMed Central  Google Scholar 

  3. Hsiao CY, Yang CY, Wu JM, Kuo TC, Tien YW. Utility of the 2006 Sendai and 2012 Fukuoka guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas: A single-center experience with 138 surgically treated patients. Medicine (Baltimore). 2016;95(38):e4922. https://doi.org/10.1097/md.0000000000004922.

    Article  PubMed Central  Google Scholar 

  4. LaFemina J, Katabi N, Klimstra D, Correa-Gallego C, Gaujoux S, Kingham TP et al. Malignant Progression in IPMN: A Cohort Analysis of Patients Initially Selected for Resection or Observation. Ann Surg Oncol. 2013;20(2):440-7. https://doi.org/10.1245/s10434-012-2702-y.

    Article  CAS  Google Scholar 

  5. Falconi M, Crippa S, Chari S, Conlon K, Kim SW, Levy P et al. Quality assessment of the guidelines on cystic neoplasms of the pancreas. Pancreatology. 2015;15(5):463-9. https://doi.org/10.1016/j.pan.2015.05.478.

    Article  Google Scholar 

  6. Sighinolfi M, Quan SY, Lee Y, Ibaseta A, Pham K, Dua MM et al. Fukuoka and AGA Criteria Have Superior Diagnostic Accuracy for Advanced Cystic Neoplasms than Sendai Criteria. Dig Dis Sci. 2017;62(3):626-32. https://doi.org/10.1007/s10620-017-4460-y.

    Article  Google Scholar 

  7. Del Chiaro M, Verbeke C, Salvia R, Kloppel G, Werner J, McKay C et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis. 2013;45(9):703-11. https://doi.org/10.1016/j.dld.2013.01.010.

    Article  Google Scholar 

  8. Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183-97. https://doi.org/10.1016/j.pan.2012.04.004.

    Article  Google Scholar 

  9. Vege SS, Ziring B, Jain R, Moayyedi P. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):819-22; quize12-3. https://doi.org/10.1053/j.gastro.2015.01.015.

    Article  Google Scholar 

  10. M. H, L. B, U. H, T. P, C. T, J. K et al. European evidence-based guidelines on pancreatic cystic neoplasms. Gut. 2018;67(5):789-804. https://doi.org/10.1136/gutjnl-2018-316027.

  11. Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV et al. A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas. Am J Surg Pathol. 2015;39(12):1730-41. https://doi.org/10.1097/pas.0000000000000533.

    Article  PubMed Central  Google Scholar 

  12. Tanaka M, Fernandez-Del Castillo C, Kamisawa T, Jang JY, Levy P, Ohtsuka T et al. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017;17(5):738-53. https://doi.org/10.1016/j.pan.2017.07.007.

    Article  Google Scholar 

  13. Yu S, Takasu N, Watanabe T, Fukumoto T, Okazaki S, Tezuka K et al. Validation of the 2012 Fukuoka Consensus Guideline for Intraductal Papillary Mucinous Neoplasm of the Pancreas From a Single Institution Experience. Pancreas. 2017;46(7):936-42. https://doi.org/10.1097/mpa.0000000000000874.

    Article  Google Scholar 

  14. Srinivasan N, Teo J-Y, Chin Y-K, Hennedige T, Tan DM, Low AS et al. Systematic review of the clinical utility and validity of the Sendai and Fukuoka Consensus Guidelines for the management of intraductal papillary mucinous neoplasms of the pancreas. HPB (Oxford). 2018;20(6):497-504. https://doi.org/10.1016/j.hpb.2018.01.009.

    Article  Google Scholar 

  15. Zhou W, Xu Y, Rong Y, Wu W, Kuang T, **n B et al. Validation of Sendai and Fukuoka consensus guidelines in predicting malignancy in patients with preoperatively diagnosed mucinous pancreatic cystic neoplasms. J Surg Oncol. 2017;117(3):409-16. https://doi.org/10.1002/jso.24882.

    Article  Google Scholar 

  16. Wong J, Weber JA Centeno B, Vignesh S, Harris CL, Klapman JB et al. High-Grade Dysplasia and Adenocarcinoma Are Frequent in Side-Branch Intraductal Papillary Mucinous Neoplasm Measuring Less than 3 cm on Endoscopic Ultrasound. J Gastrointest Surg. 2013;17(1):78-85. https://doi.org/10.1007/s11605-012-2017-0.

    Article  Google Scholar 

  17. Fritz S, Klauss M, Bergmann F, Hackert T, Hartwig W, Strobel O et al. Small (Sendai Negative) Branch-Duct IPMNs: Not Harmless. Ann Surg. 2012;256(2):313-20. https://doi.org/10.1097/SLA.0b013e31825d355f.

    Article  Google Scholar 

  18. Heckler M, Brieger L, Heger U, Pausch T, Tjaden C, Kaiser J et al. Predictive performance of factors associated with malignancy in intraductal papillary mucinous neoplasia of the pancreas. BJS Open. 2018;2(1):13-24. https://doi.org/10.1002/bjs5.38.

    Article  CAS  PubMed Central  Google Scholar 

  19. Aggarwal G, Rabe KG, Petersen GM, Chari ST. New-onset diabetes in pancreatic cancer: a study in the primary care setting. Pancreatology. 2012;12(2):156-61. https://doi.org/10.1016/j.pan.2012.02.003.

    Article  PubMed Central  Google Scholar 

  20. Pannala R, Leibson CL, Rabe KG, Timmons LJ, Ransom J, de Andrade M et al. Temporal association of changes in fasting blood glucose and body mass index with diagnosis of pancreatic cancer. Am J Gastroenterol. 2009;104(9):2318-25. https://doi.org/10.1038/ajg.2009.253.

    Article  PubMed Central  Google Scholar 

  21. Raghavan SR, Ballehaninna UK, Chamberlain RS. The impact of perioperative blood glucose levels on pancreatic cancer prognosis and surgical outcomes: an evidence-based review. Pancreas. 2013;42(8):1210-7. https://doi.org/10.1097/MPA.0b013e3182a6db8e.

    Article  CAS  Google Scholar 

  22. Khadka R, Tian W, Hao X, Koirala R. Risk factor, early diagnosis and overall survival on outcome of association between pancreatic cancer and diabetes mellitus: Changes and advances, a review. Int J Surg. 2018;52:342-6. https://doi.org/10.1016/j.ijsu.2018.02.058.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Laboratory Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan

    I-Shiow Jan

  2. Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    I-Shiow Jan

  3. Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan

    Ming-Chu Chang & Yu-Ting Chang

  4. Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung Shan South Road, Taipei, 100, Taiwan

    Ming-Chu Chang & Yu-Ting Chang

  5. Department of Surgery, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan

    Ching-Yao Yang & Yu-Wen Tien

  6. Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Ching-Yao Yang & Yu-Wen Tien

  7. Department of Pathology, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan

    Yung-Ming Jeng

  8. Department of Pathology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Yung-Ming Jeng

  9. Department of Medical Image, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan

    Chih-Horng Wu & Bang-Bin Chen

  10. Department of Medical Image, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan

    Chih-Horng Wu & Bang-Bin Chen

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  1. I-Shiow Jan
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Contributions

I-Shiow Jan: contributions to the design of study, interpretation of data, and drafting the manuscript. Ming-Chu Chang, Ching-Yao Yang, Yu-Wen Tien, Yung-Ming Jeng, Chih-Horng Wu, and Bang-Bin Chen: contributions to acquisition, analysis, and interpretation of data and assisting in drafting the manuscript. Yu-Ting Chang: contributions to the design of the study, acquisition, analysis, and interpretation of data, drafting the manuscript, and final approval of the version to be published.

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Correspondence to Yu-Ting Chang.

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Jan, IS., Chang, MC., Yang, CY. et al. Validation of Indications for Surgery of European Evidence-Based Guidelines for Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms. J Gastrointest Surg 24, 2536–2543 (2020). https://doi.org/10.1007/s11605-019-04420-9

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