Intraductal papillary mucinous neoplasms: Have IAP Consensus Guidelines changed our approach?: Results from a multi-institutional study Journal Article

   


Authors: Pulvirenti, A.; Margonis, G. A.; Morales-Oyarvide, V.; McIntyre, C. A.; Lawrence, S. A.; Goldman, D. A.; Gonen, M.; Weiss, M. J.; Ferrone, C. R.; He, J.; Brennan, M. F.; Cameron, J. L.; Lillemoe, K. D.; Kingham, T. P.; Balachandran, V.; Qadan, M.; D'Angelica, M. I.; Jarnagin, W. R.; Wolfgang, C. L.; Castillo, C. F. D.; Allen, P. J.
Article Title: Intraductal papillary mucinous neoplasms: Have IAP Consensus Guidelines changed our approach?: Results from a multi-institutional study
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. © 2021 Lippincott Williams and Wilkins. All rights reserved.
Keywords: adult; controlled study; aged; aged, 80 and over; middle aged; cancer surgery; major clinical study; clinical trial; histopathology; cancer patient; pancreatic neoplasms; cancer staging; nuclear magnetic resonance imaging; neoplasm staging; cancer grading; adenocarcinoma; pancreas; consensus; computer assisted tomography; intraductal papillary mucinous tumor; adenocarcinoma, mucinous; carcinoma, pancreatic ductal; practice guideline; pathology; diagnostic imaging; high risk patient; pancreas carcinoma; multicenter study; pancreas tumor; practice guidelines as topic; colloid carcinoma; guidelines; adenocarcinoma, papillary; dysplasia; massachusetts; general hospital; intraductal papillary mucinous neoplasm; protocol compliance; ipmn; neoplasm grading; very elderly; cancer; humans; human; male; female; article; pancreatic surgery consortium; radiographic features; pancreatic duct
Journal Title: Annals of Surgery
Volume: 274
Issue: 6
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins  
Date Published: 2021-12-01
Start Page: e980
End Page: e987
Language: English
DOI: 10.1097/sla.0000000000003703
PUBMED: 31804389
PROVIDER: scopus
PMCID: PMC8503800
DOI/URL:

https://www.scopus.com/inward/record.uri?eid=2-s2.0-85121718378&doi=10.1097%2fSLA.0000000000003703&partnerID=40&md5=9b8199fb356aed792308764d15d4afed
Notes: Article -- Export Date: 1 February 2022 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    1059 Brennan
  2. Mithat Gonen
    1031 Gonen
  3. William R Jarnagin
    907 Jarnagin
  4. Michael D'Angelica
    781 D'Angelica
  5. T Peter Kingham
    618 Kingham
  6. Vinod P Balachandran
    254 Balachandran
  7. Debra Alyssa Goldman
    158 Goldman
  8. Sharon Anita Lawrence
    15 Lawrence
  9. Alessandra Pulvirenti
    30 Pulvirenti
  10. Caitlin Anne McIntyre
    39 McIntyre
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