Abstract
Background
The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with
main pancreatic duct involvement is 33%–60%. Most guidelines, therefore, advise resection
of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary
mucinous neoplasm in surgically fit patients, although advice on the surgical strategy
(partial or total pancreatectomy) differs. We performed a survey amongst international
experts to guide the design of future studies and help to prepare for a single international
set of guidelines.
Methods
An online survey including case vignettes was sent to 221 international experts who
had published on main duct/mixed type intraductal papillary mucinous neoplasm in the
previous decade and to all surgeon and gastroenterologist members of the pancreatic
cyst guideline committees of the European Study Group and the International Association
of Pancreatology.
Results
Overall, 97 experts (67 surgeons, 30 gastroenterologists) from 19 countries replied
(44% response rate). Most (93%) worked in an academic hospital, with a median of 15
years’ experience with intraductal papillary mucinous neoplasm treatment. In main
duct/mixed type intraductal papillary mucinous neoplasm patients with pancreatic duct
dilation (>5 mm) in the entire pancreas, 41% (n = 37) advised nonoperative surveillance every 3–6 months, whereas 59% (n = 54) advised operative intervention. Of those who advised operative intervention,
46% (n = 25) would perform a total pancreatectomy and 31% (n = 17) pancreatoduodenectomy with follow-up. No structural differences in advice were
seen between surgeons and gastroenterologists, between continents where the respondents
lived, and based on years of experience.
Conclusion
This international survey identified a clinically relevant lack of consensus in the
treatment strategy in main duct/mixed type intraductal papillary mucinous neoplasm
among experts. Studies with long-term follow-up including quality of life after partial
and total pancreatectomy for main duct/mixed type intraductal papillary mucinous neoplasm
are required.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.Am J Surg Pathol. 2004; 28: 977-987
- International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.Pancreatology. 2006; 6: 17-32
- Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics.Clin Gastroenterol Hepatol. 2010; 8: 213-219
- Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology.Ann Surg. 2007; 246 (discussion 651-4): 644-651
- Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection.Ann Surg. 2004; 239 (discussion 685-7): 678-685
- Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 118 consecutive patients from a single center.J Hepatobiliary Pancreat Surg. 2008; 15: 183-188
- European evidence-based guidelines on pancreatic cystic neoplasms.Gut. 2018; 67: 789-804
- Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation.Ann Surg. 2005; 242 (discussion 778-80): 774-778
- Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.Pancreatology. 2017; 17: 738-753
- Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas.Am J Surg. 2012; 204: 44-48
- Long-term prospective cohort study of patients undergoing pancreatectomy for intraductal papillary mucinous neoplasm of the pancreas: implications for postoperative surveillance.Ann Surg. 2014; 260: 356-363
- Oncocytic-type intraductal papillary mucinous neoplasms: a unique malignant pancreatic tumor with good long-term prognosis.J Am Coll Surg. 2015; 220: 839-844
- Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs.Gastroenterol Res Pract. 2014; 2014:269803
- Clinical Guidelines Committee; American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts.Gastroenterology. 2015; 148 (quiz e12-3): 819-822
- Outcomes of nonresected main-duct intraductal papillary mucinous neoplasms of the pancreas.World J Gastroenterol. 2015; 21: 2658-2667
- Predictors of malignancy and natural history of main-duct intraductal papillary mucinous neoplasms of the pancreas.Pancreas. 2011; 40: 371-375
- Nonoperative management of main pancreatic duct-involved intraductal papillary mucinous neoplasm might be indicated in select patients.J Am Coll Surg. 2014; 219: 122-129
- A natural course of main duct intraductal papillary mucinous neoplasm of the pancreas with lower likelihood of malignancy.Pancreas. 2010; 39: 653-657
- Comparing 3 guidelines on the management of surgically removed pancreatic cysts with regard to pathological outcome.Gastrointest Endosc. 2017; 85: 1025-1031
- Comparison of the international consensus guidelines for predicting malignancy in intraductal papillary mucinous neoplasms.Surgery. 2016; 159: 878-884
- Sendai and Fukuoka Consensus Guidelines Identify Advanced Neoplasia in Patients With Suspected Mucinous Cystic Neoplasms of the Pancreas.Clin Gastroenterol Hepatol. 2015; 13: 1808-1815
- American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data.Gastrointest Endosc. 2016; 83 (e2): 1107-1117
- Quality-of-life after total pancreatectomy: is it really that bad on long-term follow-up?.J Gastrointest Surg. 2005; 9 (discussion 1066-7): 1059-1066
- Long-term outcomes after total pancreatectomy: special reference to survivors' living conditions and quality of life.World J Surg. 2015; 39: 1231-1239
- Quality of life in patients after total pancreatectomy is comparable with quality of life in patients who undergo a partial pancreatic resection.J Surg Res. 2014; 187: 189-196
- Is there still a role for total pancreatectomy?.Ann Surg. 2007; 246 (discussion 974-5): 966-974
- How severe is diabetes after total pancreatectomy? A case-matched analysis.HPB (Oxford). 2014; 16: 814-821
Article info
Publication history
Published online: May 17, 2018
Accepted:
January 29,
2018
Received in revised form:
January 24,
2018
Received:
August 29,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
