• Br J Surg · Jun 2022

    Multicenter Study

    Identification of patients with branch-duct intraductal papillary mucinous neoplasm and very low risk of cancer: multicentre study.

    • Domenico Tamburrino, Nicolò de Pretis, Enrique Pérez-Cuadrado-Robles, Laura Uribarri-Gonzalez, Zeeshan Ateeb, Giulio Belfiori, Patrick Maisonneuve, Gabriele Capurso, Giuseppe Vanella, Maria Chiara Petrone, Paolo Giorgio Arcidiacono, Yrjo Vaalavuo, Luca Frulloni, J Enrique Dominguez-Muñoz, Pierre H Deprez, Massimo Falconi, Marco Del Chiaro, Stefano Crippa, and Johanna Laukkarinen.
    • Pancreatic Surgery Unit, Vita-Salute University, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute IRCCS, Milan, Italy.
    • Br J Surg. 2022 Jun 14; 109 (7): 617622617-622.

    BackgroundDifferent 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.MethodsThis 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.ResultsOf 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).ConclusionConservative management of patients with low-risk BD-IPMN is safe and feasible.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd.

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