Validation of Indications for Surgery of European Evidence-Based Guidelines for Patients with Pancreatic Intraductal Pap
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ORIGINAL ARTICLE
Validation of Indications for Surgery of European Evidence-Based Guidelines for Patients with Pancreatic Intraductal Papillary Mucinous Neoplasms I-Shiow Jan 1,2 & Ming-Chu Chang 3,4 & Ching-Yao Yang 5,6 & Yu-Wen Tien 5,6 & Yung-Ming Jeng 7,8 & Chih-Horng Wu 9,10 & Bang-Bin Chen 9,10 & Yu-Ting Chang 3,4
# 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Which patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) should undergo surgical intervention remains a controversial issue. The aim of this retrospective study was to validate the new European evidence-based guidelines on pancreatic cystic neoplasms (EEBGPCN) for the management of IPMNs. Methods One hundred fifty-eight patients with resected IPMNs at National Taiwan University Hospital between January 1994 and December 2016 were enrolled. Clinical information, including new-onset diabetes mellitus (DM) and preoperative CA 19-9 levels, were collected. All patients were stratified into three groups—absolute, relative indications, and conservative approach— according to EEBGPCN. The performance characteristics of EEBGPCN for high-grade dysplasia (HGD)/invasive carcinoma (IC) of IPMNs were calculated. Results One hundred seven (67.7%) patients with low-grade dysplasia and 51 patients with HGD/IC, including 10 HGD and 41 IC, were analyzed. The missed rate for HGD/IC by EEBGPCN was 1.9% (3/158). The sensitivity, specificity, positive and negative predictive values, and accuracy of the absolute or relative indications for resecting IPMN according to EEBGPCN were 94.1%, 28.0%, 38.4%, 90.9%, and 49.4%. Jaundice, enhancing mural nodule < 5 mm, cyst diameter > 40 mm, increased levels of serum CA 19-9, new-onset DM, and main pancreatic duct dilation were associated with HGD/IC. Conclusions The missed rate for HGD/IC is low by EEBGPCN. Increased serum CA 19-9 and new-onset DM in EEBGPCN were verified as the indications for the surgical resection of IPMNs. Keywords Intraductal papillary mucinous neoplasms (IPMNs) . New-onset diabetes mellitus (DM) . European evidence-based guidelines
* Yu-Ting Chang [email protected] 1
Department of Laboratory Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
2
Department of Laboratory Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
3
4
Department of Internal Medicine, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7 Chung Shan South Road, Taipei 100, Taiwan
5
Department of Surgery, National Taiwan University College of Medicine, National Taiwan University, Taipei, Taiwan
6
Department of Surgery, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
7
Department of Pathology, National Taiwan University College of Medicine, National Taiwan U
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