A retrospective study of histological outcome for IPMN after surgery in Lausanne, Switzerland: A case series. (December 2020) - Litchinko, Alexis
Abstract: Introduction: Intraductal papillary mucinous neoplasm (IPMN) is a 21st century concept and its management is still controversial. Strong guidelines suggest that surgery is the safest way to prevent malignant evolution. Though the risk of neoplasia is still debated, high-morbidity and mortality surgery must be proposed for high-risk patients to prevent malignant and most likely fatal pancreatic neoplasia. Methods: The aim of this study was to analyze histological results of patients who underwent operation for IPMN under the Sendai and Fukuoka guidelines. From January 2005 to August 2016, 491 consecutive patients who underwent pancreatic resection in Lausanne University Hospital were analyzed, including 18 IPMN with surgical indication according to the Sendai and Fukuoka criteria. Results: Thirteen (68.4%) patients had benign histopathology after surgery (the non-malignant group). Of the patients with malignant pathology, four (21%) had high-grade dysplasia and two (20.1%) had invasive carcinoma (the malignant group). The median patient age ( p = 0.011) and preoperative Carbohydrate Antigen 19–9 (CA19-9) ( p = 0.030) were significantly higher in the malignant group than in the non-malignant group. Discussion: The use of the current criteria is adequate, but it may be resulting in surgery on excessive numbers of patients with IPMN. A modern decision-making strategy should be based on clinical features, precise imaging data, and biological markers. Highlights: IPMNs are pre-cancerous tumors with a potential evolution to malignant neoplasm. Revised guidelines can lead to surgical decision but with high morbidity and mortality linked to pancreatic surgery. Moderns biological markers can help to adjust surgical criteria, added to clinical and imaging features. More specific criteria are needed prior to resection, and could lead to more and more conservative management.