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

  • I-Shiow Jan
  • Ming-Chu Chang
  • Ching-Yao Yang
  • Yu-Wen Tien
  • Yung-Ming Jeng
  • Chih-Horng Wu
  • Bang-Bin Chen
  • Yu-Ting ChangEmail author
Original Article

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.

Keywords

Intraductal papillary mucinous neoplasms (IPMNs) New-onset diabetes mellitus (DM) European evidence-based guidelines 

Notes

Author 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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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • I-Shiow Jan
    • 1
    • 2
  • Ming-Chu Chang
    • 3
    • 4
  • Ching-Yao Yang
    • 5
    • 6
  • Yu-Wen Tien
    • 5
    • 6
  • Yung-Ming Jeng
    • 7
    • 8
  • Chih-Horng Wu
    • 9
    • 10
  • Bang-Bin Chen
    • 9
    • 10
  • Yu-Ting Chang
    • 3
    • 4
    Email author
  1. 1.Department of Laboratory Medicine, National Taiwan University College of MedicineNational Taiwan UniversityTaipeiTaiwan
  2. 2.Department of Laboratory Medicine, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  3. 3.Department of Internal Medicine, National Taiwan University College of MedicineNational Taiwan UniversityTaipeiTaiwan
  4. 4.Department of Internal Medicine, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  5. 5.Department of Surgery, National Taiwan University College of MedicineNational Taiwan UniversityTaipeiTaiwan
  6. 6.Department of Surgery, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  7. 7.Department of Pathology, National Taiwan University College of MedicineNational Taiwan UniversityTaipeiTaiwan
  8. 8.Department of Pathology, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan
  9. 9.Department of Medical Image, National Taiwan University College of MedicineNational Taiwan UniversityTaipeiTaiwan
  10. 10.Department of Medical Image, National Taiwan University Hospital, College of MedicineNational Taiwan UniversityTaipeiTaiwan

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