Clinical outcome of conservatively managed pancreatic intraductal papillary mucinous neoplasms with mural nodules and ma
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ORIGINAL ARTICLE—LIVER, PANCREAS, AND BILIARY TRACT
Clinical outcome of conservatively managed pancreatic intraductal papillary mucinous neoplasms with mural nodules and main duct dilation Arata Sakai1 • Atsuhiro Masuda1 • Takaaki Eguchi2 • Takahiro Anami3 • Katsuhisa Nishi4 • Keisuke Furumatsu5 • Yoshihiro Okabe6 • Saori Kakuyama7 Yu Sato8 • Chiharu Nishioka9 • Tsuyoshi Sanuki10 • Yosuke Yagi11 • Takashi Kobayashi1 • Hideyuki Shiomi1 • Yuzo Kodama1
•
Received: 17 June 2020 / Accepted: 15 October 2020 Ó Japanese Society of Gastroenterology 2020
Abstract Background Surgical resection of intraductal papillary mucinous neoplasm (IPMN) is strongly recommended for patients exhibiting high-risk stigmata (HRS). However, determining surgical indications for elderly patients with comorbidities is challenging, as clinical outcomes are not well characterized. This multicenter observational study elucidated the clinical outcomes of patients with IPMN exhibiting HRS who did not undergo surgery. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00535-020-01739-y) contains supplementary material, which is available to authorized users. & Atsuhiro Masuda [email protected] 1
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 75-1 Kusunoki-cho, Chuo-ku, Kobe 650-0071, Japan
2
Department of Gastroenterology and Hepatology, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
3
Department of Gastroenterology, Yodogawa Christian Hospital, Osaka, Japan
4
Department of Gastroenterology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
5
Department of Gastroenterology, Akashi Medical Center, Akashi, Japan
6
Department of Gastroenterology, Kakogawa Central City Hospital, Kakogawa, Japan
7
Department of Gastroenterology, Takatsuki General Hospital, Takatsuki, Japan
8
Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
Methods This study enrolled 101 IPMN patients exhibiting HRS with follow-up observations at 11 hospitals in Japan (2011–2016). The median observation period was 37 months (maximum: 86 months). Primary outcomes were estimated 5-year overall survival (OS) and diseasespecific survival (DSS). Survival was also stratified based on HRS features. Results Of 101 patients, 32 (31.7%) had the main pancreatic duct (MPD) measuring C 10 mm and 80 (79.2%) 9
Division of Gastroenterology, Konan Medical Center, Kobe, Japan
10
Department of Gastroenterology, Kita-harima Medical Center, Ono, Japan
11
Department of Internal Medicine, Shiso Municipal Hospital, Shiso, Japan
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J Gastroenterol
had mural nodules measuring C 5 mm. The estimated 5-year OS and DSS were 74% and 91%, respectively. In the stratified analysis, the co-presence of MPD C 10 mm and mural nodules C 5 mm or mural nodule C 10 mm were related to worse 5-year DSS (MPD C 10 mm and mural nodules C 5 mm vs other characteristics: 60% vs 95%, log-rank test: p = 0.049; mural nodules C 10 mm vs \ 10 mm: 77% vs 95%, log-
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