Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)

Abstract

Background/Purpose: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. Methods: A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien–Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. Results: A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55–72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50–82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 (P=0.016), intrahepatic versus extrahepatic tumor (P=0.027), single versus multiple tumors (P=0.007), those who underwent hepatic versus pancreatic resection (P=0.017), or achieved versus failed TO (P=0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11–15.94; P=0.03) was an independent prognostic factor of poor overall survival. Conclusions: Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.

A Case of High-Dose-Rate Brachytherapy Under Endoscopic Retrograde Cholangiopancreatography (ERCP) for Intraductal Papillary Neoplasm of the Bile Duct

“…In this case, the exact location of tumor extension could not be determined by contrast-enhanced CT alone, and POCS was performed to determine that the tumor extended to the lower common bile duct. An analysis of patients who underwent surgery for IPNB reported a significantly lower overall survival for patients with extrahepatic extension of the tumor compared to those with intrahepatic localization of the tumor, suggesting that POCS plays an essential role in preoperative diagnosis [ 9 ].…”

Current considerations on intraductal papillary neoplasms of the bile duct and pancreatic duct

“…A recent European multicenter study showed a median postoperative survival of 5.7 years and a 5-year overall survival of 63%[ 17 ]. In unfit patients, novel endoscopic resection[ 1 ], endoscopic radiofrequency ablation or photodynamic therapy can be performed[ 8 ].…”

A commentary on ‘Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB Study)’

“…We read the article by Lluís et al . 1 recently published in the International Journal of Surgery with great interest and pleasure. This study comprised the largest number of centers and patients to date in Europe for a study providing surgical strategies and outcomes of intraductal papillary neoplasm of the bile duct (IPNB) and is the first to apply textbook outcome (TO) as a prognostic factor in patients with IPNB.…”