Asymptomatic Pancreatic Cystic Neoplasms: Maximizing Survival and Quality of Life Using Markov-Based Clinical Nomograms

Weinberg, Benjamin H.; Spiegel, Brennan M.; Tomlinson, James S.; Farrell, James J.

doi:10.1053/j.gastro.2009.10.001

Cited by 99 publications

(61 citation statements)

References 75 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In tumors with a diameter Ͻ2 cm, malignancy is rare in the absence of additional typical radiographic findings. In an attempt to stratify the indication for surgery in BD-IPMN by age and quality of life, Weinberg and coworkers conducted a Markov-based clinical nomogram for BD-IPMN of the pancreatic head [97]. They revealed that, for patients merely focusing on longest survival, regardless of quality of life, all BD-IPMNs Ͼ2 cm should be surgically removed.…”

Section: Prediction Of Malignancy In Ipmnmentioning

confidence: 99%

Intraductal Papillary Mucinous Tumors of the Pancreas: Biology, Diagnosis, and Treatment

et al. 2010

View full text Add to dashboard Cite

show abstract

Section: Prediction Of Malignancy In Ipmnmentioning

confidence: 99%

Intraductal Papillary Mucinous Tumors of the Pancreas: Biology, Diagnosis, and Treatment

et al. 2010

View full text Add to dashboard Cite

show abstract

“…Some patients present symptoms at the time of diagnosis (7-43%), being more frequent the presence of abdominal pain, jaundice, and previous history of pancreatitis.Othersymptomsareasfollows:weightloss,nauseaorvomiting,anddiabetes [5,6,27].…”

Section: Symptomsmentioning

confidence: 99%

“…These factors support a conservative management with follow-up in patients who do not have risk factors predicting malignancy. Younger patients (<65 years) with a cyst size of>2cmmaybecandidatesforresectionowingtothecumulativeriskofmalignancy [27].…”

Section: Positivecytologyoneus-guidedfnahasthehighestspecificityfordimentioning

confidence: 99%

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights

Carroll¹,

Reyes²,

Vázquez³

2017

Challenges in Pancreatic Pathology

View full text Add to dashboard Cite

Cystic lesions of the pancreas are a common entity with almost a 25% incidence of the general population. These types of lesions are being increasingly diagnosed partly explained due to the technological advances over the past years. The management and treatment varies per cyst type. However, the most threatening cyst lesions are intraductal papillary mucinous neoplasms (IPMNs). These lesions represent nowadays a relatively new clinical entity and in many aspects remain poorly understood. The aim of this chapteristoprovideacomprehensivereviewoftheclassification,diagnosis,treatment and follow-up strategy.

show abstract

“…However, for the same age group (85 years and older) stopping surveillance is also favored for any pancreatic cyst size irrespective of any operative risk approach, when the primary interest is improving quality-adjusted survival. Th is is likely due to the poor quality of life experienced postoperatively oft en outweighing the minimal benefi t derived from surgical resection in this population ( 6 ).…”

mentioning

confidence: 99%

“…While their study did confi rm a very high disease specifi c survival of 98.6% for BD-IPMNs without WF/ HRS on long-term surveillance at 12 years (as has been seen in other studies), the most startling fi nding is that 26(18%) patients under surveillance in this study developed either WF or HRS during surveillance beyond 5 years. Th e authors argue that their data ing overall survival and quality of life ( 6 ). Using these models, surgery is the preferred strategy for patients who value overall survival regardless of quality of life for any cyst size greater than 2 cm even aft er considering the possibility that the cyst is not malignant.…”

mentioning

confidence: 99%

Editorial: Stopping Pancreatic Cyst Surveillance?

Farrell¹

2017

American Journal of Gastroenterology

View full text Add to dashboard Cite

Abstract:The management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge. BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who often die from causes not related to their pancreatic disease. The specifi c decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy and IPMNrelated mortality, with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes. With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical. Am J Gastroenterol 2017; 112:1162-1164 doi: 10.1038/ajg.2017 Th e management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge ( 1 ). BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who oft en die from causes not related to their pancreatic disease. Th e specifi c decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy (0.007 per person-years of follow-up) and IPMN-related mortality (0.9%), with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes ( 2,3 ). With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical.Factors favoring ongoing indefi nite surveillance for presumed BD-IPMNs include the persistence of the malignant risk, the unpredictable natural history of an individual pancreatic cyst, the lack of understanding about the biology driving malignant progression, and the growing concern for concomitant pancreatic ductal adenocarcinoma elsewhere in the pancreatic gland ( 1,3 ). However, the arguments in favor of stopping surveillance are oft en equally strong, including the overall likely low rates of malignant change, economic and social cost off sets associated with indefi nite surveillance imaging, lack of eff ective treatment, and good outcomes for patients who develop malignancy during surveillance, risks associated with invasive surveillance imaging such as endoscopic ultrasound, and the high rates of morbidity and mortality associated with surgical resection. Putting aside that BD-IPMNs are diffi cult to accurately diagnose, and that there is currently no standardization for measuring them during surveillance, several factors do exist to help guide decision making about cessation of low risk presumed BD-IPMN sur...

show abstract

Asymptomatic Pancreatic Cystic Neoplasms: Maximizing Survival and Quality of Life Using Markov-Based Clinical Nomograms

Abstract: Background-The natural history and management of pancreatic cysts, especially for branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains uncertain. We developed evidencebased nomograms to assist with clinical decision-making.

Cited by 99 publications

References 75 publications

Intraductal Papillary Mucinous Tumors of the Pancreas: Biology, Diagnosis, and Treatment

Intraductal Papillary Mucinous Tumors of the Pancreas: Biology, Diagnosis, and Treatment

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights

Editorial: Stopping Pancreatic Cyst Surveillance?

Contact Info

Product

Resources

About