The European evidence-based guidelines on pancreatic cystic neoplasms (PCN) in clinical practice: The development of relative and absolute indications for surgery during prospective IPMN surveillance |
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| Affiliation: | 1. Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland;2. Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland;3. Dept. of Radiology, Tampere University Hospital, Tampere, Finland;1. Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan;2. Department of Gastroenterology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan;3. Department of Hepatopancreatobiliary Medicine, Kanazawa Medical University Japan;1. Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola, Italy;2. Endoscopy Unit, Hôpital privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France;3. Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) “Dino Amadori,” Meldola, Itally;4. Department of Medicine, Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, University Hospital of Verona, Verona, Italy;5. Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy;6. Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan;7. Department of Surgery, Verona University Hospital Trust, Verona, Italy;1. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan;3. Vita-Salute San Raffaele University, Milan;4. Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan;6. Department of Radiology, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar (VR);5. Division of Pancreato-Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan;7. Department of Pathology, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy;1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Japan;2. Division of Diagnostic Pathology, Kobe University Graduate School of Medicine, Japan;3. Department of Gastroenterology and Hepatology, Kinki University Hospital, Faculty of Medicine, Japan;4. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Japan;5. Department of Radiology, Kobe University Graduate School of Medicine, Japan;6. Center for Clinical Research and Advanced Medicine Establishment, Shiga University of Medical Science, Japan;1. Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan;2. Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan |
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| Abstract: | IntroductionThe European evidence-based guidelines on PCN recommend surveillance for IPMN patients who are fit for surgery but who have no indication for immediate surgery. Our aim was to demonstrate the feasibility of the new guidelines in clinical practice.MethodsThis is a prospective cohort study of patients included in the IPMN register in Tampere University Hospital, Finland. IPMN was diagnosed from January 1, 2013 to December 31, 2018. Patients were analyzed for surveillance and indications for surgery according to the European guidelines on PCN.ResultsOut of 128 patients in register 23 was decided to operate upfront and 105 patients were included in the surveillance programme. Invasive carcinoma was found in 4/23 of operated patients. Median follow-up time was 26 months (6–69). Median size of the cyst at the beginning and end of the surveillance was 16 mm (4–58 mm). During surveillance 0/105 (0.0%) patients had or developed an absolute indication for surgery. Relative indication for surgery was present in 8/105 (7.6%) patients in the beginning surveillance and 9/105 (8.6%) patients developed at least one relative indication for surgery during surveillance. From the surveillance cohort 2/105 patients were operated. Surveillance was abandoned in 15/105 (14.1%) patients all due to poor general condition or other medical conditions.ConclusionsIn clinical practice, surveillance of IPMN according to the European guidelines on PCN is feasible. Among our patients 16% were detected to have relative indications for surgery during the median 26 (range 3–135) months of surveillance. Nearly 15% became surgically unfit during surveillance period. |
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| Keywords: | Surveillance Intraductal papillary mucinous neoplasms of the pancreas (IPMN) Pancreatic cancer |
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