Intraductal Papillary Mucinous Neoplasms: Have IAP Consensus Guidelines Changed our Approach?. Issue 6 (December 2021)

• Record Type: Journal Article
• Authors: Pulvirenti, Alessandra; Margonis, Georgios A.; Morales-Oyarvide, Vicente; McIntyre, Caitlin A.; Lawrence, Sharon A.; Goldman, Debra A.; Gonen, Mithat; Weiss, Matthew J.; Ferrone, Cristina R.; He, Jin; Brennan, Murray F.; Cameron, John L.; Lillemoe, Keith D.; Kingham, T. Peter; Balachandran, Vinod; Qadan, Motaz; D'Angelica, Michael I.; Jarnagin, William R.; Wolfgang, Christopher L.; Castillo, Carlos Fernández-del; Allen, Peter J.
• Is Part Of: Annals of surgery. Volume 274:Issue 6(2021)
• Publication Date: 2021-12
• Subjects: cancer -- dysplasia -- guidelines -- intraductal papillary mucinous neoplasm -- IPMN -- pancreas -- pancreatic surgery consortium -- radiographic features; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003703
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: To evaluate the influence of consensus guidelines on the management of intraductal papillary mucinous neoplasms (IPMN) and the subsequent changes in pathologic outcomes. Background: Over time, multiple guidelines have been developed to identify high-risk IPMN. We hypothesized that the development and implementation of guidelines should have increased the percentage of resected IPMN with high-risk disease. Methods: Memorial Sloan-Kettering (MSK), Johns Hopkins (JH), and Massachusetts General Hospital (MGH) databases were queried for resected IPMN (2000–2015). Patients were categorized into main-duct (MD-IPMN) versus branch-duct (BD-IPMN). Guideline-specific radiographic/endoscopic features were recorded. High-risk disease was defined as high-grade dysplasia/carcinoma. Fisher's exact test was used to detect differences between institutions. Logistic regression evaluated differences between time-points [preguidelines (pre-GL, before 2006), Sendai (SCG, 2006–2012), Fukuoka (FCG, after 2012)]. Results: The study included 1210 patients. The percentage of BD-IPMN with ≥1 high-risk radiographic feature differed between centers (MSK 69%, JH 60%, MGH 45%; P < 0.001). In MD-IPMN cohort, the presence of radiographic features such as solid component and main pancreatic duct diameter ≥10 mm also differed (solid component: MSK 38%, JH 30%, MGH 18%; P < 0.001; duct ≥10 mm: MSK 49%, JH 32%, MGH 44%; P < 0.001). The percentage of high-risk disease on pathology, however, was similar between institutions (BD-IPMN: P = 0.36, MD-IPMN: P = 0.48). During the study period, the percentage of BD-IPMN resected with ≥1 high-risk feature increased (52% pre-GL vs 67% FCG; P = 0.005), whereas the percentage of high-risk disease decreased (pre-GL vs FCG: 30% vs 20%). For MD-IPMN, there was not a clear trend towards guideline adherence, and the rate of high-risk disease was similar over the time (pre-GL vs FCG: 69% vs 67%; P = 0.63). Conclusion: Surgical management of IPMN based on radiographic criteria is variable between institutions, with similar percentages of high-risk disease. Over the 15-year study period, the rate of BD-IPMN resected with high-risk radiographic features increased; however, the rate of high-risk disease decreased. Better predictors are needed. Abstract : Supplemental Digital Content is available in the text