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

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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Authors

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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Keywords

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