Prognostic impact of conservative surgery for pancreatic IPMNs
| Autor: | Matteo Bianchini, Luca Pollina, Gregorio Di Franco, Andrea Sbrana, Simone Guadagni, Luca Morelli, Desirée Gianardi, Matteo Palmeri, Niccolò Furbetta, Giovanni Caprili, Lorenzo Maria Fatucchi, Niccola Funel, Giulio Di Candio |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty endocrine system diseases Pancreatic surgery Pancreatic Intraductal Neoplasms Conservative surgery Intraductal papillary mucinous neoplasms IPMN Surgical management Surgical planning Pancreaticoduodenectomy Pancreatectomy Diabetes mellitus Medicine Humans Aged Retrospective Studies Frozen section procedure business.industry Significant difference Perioperative medicine.disease Prognosis Entire gland Surgery Pancreatic Neoplasms Survival Rate Oncology Dysplasia Female Neoplasm Recurrence Local business Distal pancreatectomy Carcinoma Pancreatic Ductal Follow-Up Studies |
| Zdroj: | Surgical oncology. 38 |
| ISSN: | 1879-3320 |
| Popis: | Background The extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs. Methods We retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patients were divided into two main groups based on the extent of surgery: TP-group and CS-group. Subsequently, the perioperative and the long-term outcomes were compared. Moreover, a sub-group analysis of patients with IPMN alone and patients with malignant IPMN, based on preoperative indications to surgery and post-operative histopathological findings, was also performed. Results Fifty-three patients were included in the TP-group and 73 in the CS-group. In 50 (39.7%) cases the frozen section changed the pre-operative surgical planning, with an extension of the pancreatic resection, in 43 (34.1%) cases up to a total pancreatectomy. Twenty-six patients (20.6%) with low-grade dysplasia at the frozen section underwent CS, while twenty (15.8%) underwent TP. Comparing these two sub-groups no differences were found in surgical IPMN recurrence, nor progression. The rate of overall postoperative complications was 56.6% in the TP-group and 57.5% in the CS-group (p = 0.940). Fifteen patients (20.5%) developed diabetes in the CS-group. None of the patients treated with CS developed a surgical IPMN recurrence or progression during the follow-up period. Comparing OS and DFS of the two groups, we did not find any statistically significant difference (p = 0.619 and 0.315). Conclusion A timely CS can be considered an appropriate and valid strategy in the surgical treatment of the majority of pancreatic IPMNs, as it can avoid the serious long-term metabolic consequences of TP in patients with a long-life expectancy. On the contrary, TP remains mandatory in case of PDAC or high-risk features involving the entire gland. |
| Databáze: | OpenAIRE |
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