Indication for resection and possibility of observation for intraductal papillary mucinous neoplasm with high-risk stigmata |
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Authors: | Kodai Abe Minoru Kitago Yohei Masugi Eisuke Iwasaki Hiroshi Yagi Yuta Abe Yasushi Hasegawa Seiichiro Fukuhara Shutaro Hori Masayuki Tanaka Yutaka Nakano Takahiro Yokose Gaku Shimane Michiie Sakamoto Yuko Kitagawa |
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Affiliation: | 1. Department of Surgery, Keio University School of Medicine, Japan;2. Department of Pathology, Keio University School of Medicine, Japan;3. Department of Internal Medicine, Keio University School of Medicine, Japan |
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Abstract: | Background/ObjectivesAccording to the revised international intraductal papillary mucinous neoplasm (IPMN) guidelines (2017), the indication for surgery is based on risk classification. However, some IPMNs with high-risk stigmata (HRS) can be observed for long periods without resection. Hence, we need to reconsider the risk stratification, and this study aimed to propose a novel risk stratification for HRS-IPMNs.MethodsWe enrolled 328 patients diagnosed with IPMN using endoscopic ultrasound between 2012 and 2019. We compared clinicopathological features between HRS and worrisome features (WF) and evaluated outcomes of HRS-IPMN.ResultsFifty-three patients (HRS 38, WF 15) underwent resection at initial diagnosis and 275 patients were observed. Following observation for 30 months, 22 patients (17 HRS, 5 WF) underwent resection. Analysis of resected IPMNs (n = 75) revealed that HRS had dominantly pancreatobiliary mucin subtype. Pancreatobiliary-type IPMN had larger nodule sizes and lymphatic invasion and high recurrence with poor prognosis. Seventy-four patients were diagnosed with HRS, 55 underwent resection, and 19 continue to be observed. The resected group had larger nodule sizes (median 8 mm vs. 5 mm; P = 0.060), whereas the observed group had more main pancreatic duct (MPD) dilation (median 10 mm vs. 5 mm; P = 0.005). In the resected HRS group, only patients with MPD dilation ≥10 mm (n = 10) had no recurrence but had a favorable prognosis compared with those nodule size ≥5 mm (n = 45).ConclusionsLarge nodule size may be associated with pancreatobiliary subtype and poor prognosis; however, patients with MPD dilation ≥10 mm with nodule size <5 mm did not require resection. |
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Keywords: | IPMN Pancreatobiliary subtype Main pancreatic duct High-risk stigmata |
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