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Identification of patients with branch-duct intraductal papillary mucinous neoplasm and very low risk of cancer: multicentre study.
- Source :
-
The British journal of surgery [Br J Surg] 2022 Jun 14; Vol. 109 (7), pp. 617-622. - Publication Year :
- 2022
-
Abstract
- Background: Different surveillance strategies for patients with low-risk branch-duct (BD) intraductal papillary neoplasm (IPMN) have been described. The aim of this study was to describe the natural history of low-risk BD-IPMN, and to identify risk factors for the development of worrisome features (WF)/high-risk stigmata (HRS) and of pancreatic malignancies.<br />Methods: This was a multicentre retrospective study of patients with BD-IPMN who were under active surveillance between January 2006 and December 2015. Patients were eligible if they had a low-risk lesion and had a minimum follow-up of 24 months. Outcomes were development of WF/HRS or cytologically/histologically confirmed malignant IPMN.<br />Results: Of 837 patients included, 168 (20 per cent) developed WF/HRS. At the end of the observation time, 132 patients (79 per cent) with WF/HRS were still under surveillance without progression to pancreatic cancer. Factors associated with the development of WF or HRS in multivariable analysis included localized nodules (versus diffuse: hazard ratio (HR) 0.43, 95 per cent c.i. 0.26 to 0.68), cyst size 15-19 mm (versus less than 15 mm: HR 1.88, 1.23 to 2.87) or at least 20 mm (versus less than 15 mm: HR 3.25, 2.30 to 4.60), main pancreatic duct size over 3 mm (versus 3 mm or less: HR 2.17, 1.41 to 3.34), and symptoms at diagnosis (versus no symptoms: HR 2.29, 1.52 to 3.45). Surveillance in an endoscopy-oriented centre was also associated with increased detection of WF or HRS (versus radiology-oriented: HR 2.46, 1.74 to 3.47).<br />Conclusion: Conservative management of patients with low-risk BD-IPMN is safe and feasible.<br /> (© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.)
- Subjects :
- Humans
Pancreatic Ducts pathology
Retrospective Studies
Pancreatic Neoplasms
Carcinoma, Pancreatic Ductal diagnosis
Carcinoma, Pancreatic Ductal pathology
Pancreatic Intraductal Neoplasms diagnosis
Pancreatic Intraductal Neoplasms pathology
Pancreatic Neoplasms diagnosis
Pancreatic Neoplasms etiology
Pancreatic Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2168
- Volume :
- 109
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The British journal of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 35511697
- Full Text :
- https://doi.org/10.1093/bjs/znac103