Surgical management of intraductal papillary mucinous neoplasm with main duct involvement: an international expert survey and case-vignette study

Scholten, Lianne; Huijgevoort, Nadine C.M. van; Bruno, Marco J.; Castillo, C. Fernandez-del; Satoi, Sohei; Sauvanet, Alain; Wolfgang, Christopher L.; Fockens, Paul; Chari, Suresh T.; Chiaro, Marco Del; Hooft, Jeanin E. van; Besselink, Marc G.

doi:10.1016/j.surg.2018.01.025

Cited by 17 publications

(7 citation statements)

References 26 publications

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“…In the present review, however, the majority of patients (52·5 per cent) underwent total pancreatectomy for PDAC and 29·6 per cent for IPMN. Despite the potential benefits of total pancreatectomy as radical treatment for IPMN, international consensus regarding the role of total pancreatectomy is lacking, possibly as result of limited data on functional outcomes, QoL and long‐term survival rates compared with those for partial pancreatectomy.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, several investigators have suggested that the role of total pancreatectomy in IPMN should be expanded as the postoperative management has improved. Of note, a recent international survey showed no consensus on the use of total pancreatectomy in patients with main‐duct/mixed‐type IPMN. This lack of consensus is likely to be related to concerns regarding total pancreatectomy‐related diabetes and exocrine insufficiency.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review of functional outcome and quality of life after total pancreatectomy

Scholten¹,

Stoop²,

Chiaro

et al. 2019

British Journal of Surgery

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BackgroundSurgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking.MethodsA systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Library were searched (2005–2018). Endpoints included functional outcome and QoL.ResultsA total of 21 studies, including 1536 patients, fulfilled the eligibility criteria. During a median follow‐up of 20·8 (range 1·5–96·0) months, 18·6 per cent (45 of 242 patients) were readmitted for endocrine‐related morbidity, with associated mortality in 1·6 per cent (6 of 365 patients). No diabetes‐related mortality was reported in studies including only patients treated after 2005. Symptoms related to exocrine insufficiency were reported by 43·5 per cent (143 of 329 patients) during a median follow‐up of 15·9 (1·5–96·0) months. Overall QoL, reported by 102 patients with a median follow‐up of 28·6 (6·0–66·0) months, using the EORTC QLQ‐C30 questionnaire, showed a moderately reduced summary score of 76 per cent, compared with a general population score of 86 per cent (P = 0·004).ConclusionOverall QoL after total pancreatectomy is affected adversely, in particular by the considerable impact of diarrhoea that requires better treatment. There is also room for improvement in the management of diabetes after total pancreatectomy, particularly with regards to prevention of diabetes‐related morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review of functional outcome and quality of life after total pancreatectomy

Scholten¹,

Stoop²,

Chiaro

et al. 2019

British Journal of Surgery

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“…In particular, a main pancreatic duct of 5–9 mm did not affect disease‐specific survival 96 . Furthermore, in an international expert survey and case vignette study, 97 experts disagreed on the indication for pancreatectomy in patients with main‐duct or mixed‐type IPMN in the entire pancreas with a nodule or tumour: 41% advised surveillance whereas 59% advised operative intervention 98 . Of those who advised operative intervention, 46% would perform a total pancreatectomy and 31% pancreatoduodenectomy with follow‐up.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision‐making programme using decision tables

et al. 2020

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Background Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm, may wish to discuss prophylactic total pancreatectomy but strategies to do so are lacking. Objective To develop a shared decision-making programme for prophylactic total pancreatectomy using decision tables. Methods Focus group meetings with patients were used to identify relevant questions. Systematic reviews were performed to answer these questions. Results The first tables included hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm. No studies focused on prophylactic total pancreatectomy in these groups. In 52 studies (3570 patients), major morbidity after total pancreatectomy was 25% and 30-day mortality was 6%. After minimally invasive total pancreatectomy (seven studies, 35 patients) this was, respectively, 13% and 0%. Exocrine insufficiency-related symptoms occurred in 33%. Quality of life after total pancreatectomy was slightly lower compared with the general population. Conclusion The decision tables can be helpful for discussing prophylactic total pancreatectomy with individuals at high risk of pancreatic ductal adenocarcinoma.

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“…Although IPMNs can extend along the MPD or be a multifocal disease, none of the current guidelines currently recommend a total pancreatectomy due to the morbidity associated with patient being rendered diabetic and having definite postoperative endocrine insufficiency [ 30 , 57 ]. Despite recommendations, in an international expert survey, around half of the respondents suggested that in certain situations, they would advise total pancreatectomy [ 130 ], mainly for IPMN with MPD involvement in order to reduce the risk of recurrence. Indications for surgery in BD-IPMN also differ between the guidelines and are summarized in Table 4 .…”

Section: Management Of Ipmn and Mcnmentioning

confidence: 99%

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

Keane

Afghani

2021

JCM

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Pancreatic cystic lesions are an increasingly common clinical finding. They represent a heterogeneous group of lesions that include two of the three known precursors of pancreatic cancer, intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms (MCN). Given that approximately 8% of pancreatic cancers arise from these lesions, careful surveillance and timely surgery offers an opportunity for early curative resection in a disease with a dismal prognosis. This review summarizes the current evidence and guidelines for the diagnosis and management of IPMN/MCN. Current pre-operative diagnostic tests in pancreatic cysts are imperfect and a proportion of patients continue to undergo unnecessary surgical resection annually. Balancing cancer prevention while preventing surgical overtreatment, continues to be challenging when managing pancreatic cysts. Cyst fluid molecular markers, such as KRAS, GNAS, VHL, PIK3CA, SMAD4 and TP53, as well as emerging endoscopic technologies such as needle-based confocal laser endomicroscopy and through the needle microbiopsy forceps demonstrate improved diagnostic accuracy. Differences in management and areas of uncertainty between the guidelines are also discussed, including indications for surgery, surveillance protocols and if and when surveillance can be discontinued.

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Surgical management of intraductal papillary mucinous neoplasm with main duct involvement: an international expert survey and case-vignette study

Cited by 17 publications

References 26 publications

Systematic review of functional outcome and quality of life after total pancreatectomy

Systematic review of functional outcome and quality of life after total pancreatectomy

Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision‐making programme using decision tables

A Review of the Diagnosis and Management of Premalignant Pancreatic Cystic Lesions

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