Scholten Lianne, van Huijgevoort Nadine C M, Bruno Marco J, Fernandez-Del Castillo Carlos, Satoi Sohei, Sauvanet Alain, Wolfgang Christopher, Fockens Paul, Chari Suresh T, Del Chiaro Marco, van Hooft Jeanin E, Besselink Marc G
Department of Surgery, Cancer Center Amsterdam, Academic Medical Center Amsterdam, the Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Academic Medical Center Amsterdam, the Netherlands.
Surgery. 2018 May 16. doi: 10.1016/j.surg.2018.01.025.
The risk of invasive cancer in resected intraductal papillary mucinous neoplasm with main pancreatic duct involvement is 33%-60%. Most guidelines, therefore, advise resection of main duct intraductal papillary mucinous neoplasm and mixed type intraductal papillary mucinous neoplasm in surgically fit patients, although advice on the surgical strategy (partial or total pancreatectomy) differs. We performed a survey amongst international experts to guide the design of future studies and help to prepare for a single international set of guidelines.
An online survey including case vignettes was sent to 221 international experts who had published on main duct/mixed type intraductal papillary mucinous neoplasm in the previous decade and to all surgeon and gastroenterologist members of the pancreatic cyst guideline committees of the European Study Group and the International Association of Pancreatology.
Overall, 97 experts (67 surgeons, 30 gastroenterologists) from 19 countries replied (44% response rate). Most (93%) worked in an academic hospital, with a median of 15 years' experience with intraductal papillary mucinous neoplasm treatment. In main duct/mixed type intraductal papillary mucinous neoplasm patients with pancreatic duct dilation (>5 mm) in the entire pancreas, 41% (n = 37) advised nonoperative surveillance every 3-6 months, whereas 59% (n = 54) advised operative intervention. Of those who advised operative intervention, 46% (n = 25) would perform a total pancreatectomy and 31% (n = 17) pancreatoduodenectomy with follow-up. No structural differences in advice were seen between surgeons and gastroenterologists, between continents where the respondents lived, and based on years of experience.
This international survey identified a clinically relevant lack of consensus in the treatment strategy in main duct/mixed type intraductal papillary mucinous neoplasm among experts. Studies with long-term follow-up including quality of life after partial and total pancreatectomy for main duct/mixed type intraductal papillary mucinous neoplasm are required.
在切除的伴有主胰管受累的导管内乳头状黏液性肿瘤中，浸润性癌的风险为33%-60%。因此，大多数指南建议，对于手术适合的患者，应切除主胰管型导管内乳头状黏液性肿瘤和混合型导管内乳头状黏液性肿瘤，尽管关于手术策略（部分或全胰切除术）的建议有所不同。我们对国际专家进行了一项调查，以指导未来研究的设计，并帮助制定一套统一的国际指南。
向221位在过去十年中发表过关于主胰管/混合型导管内乳头状黏液性肿瘤文章的国际专家，以及欧洲研究小组和国际胰腺病学协会胰腺囊肿指南委员会的所有外科医生和胃肠病学家成员发送了一份包含病例 vignettes 的在线调查问卷。
总体而言，来自19个国家的97位专家（67位外科医生，30位胃肠病学家）回复了问卷（回复率为44%）。大多数（93%）在学术医院工作，治疗导管内乳头状黏液性肿瘤的中位经验为15年。在整个胰腺主胰管/混合型导管内乳头状黏液性肿瘤且胰管扩张（>5mm）的患者中，41%（n = 37）建议每3-6个月进行非手术监测，而59%（n = 54）建议进行手术干预。在建议进行手术干预的人中，46%（n = 25）会进行全胰切除术，31%（n = 17）会进行胰十二指肠切除术并进行随访。在外科医生和胃肠病学家之间、受访者所在的各大洲之间以及根据经验年限来看，建议没有结构上差异。
这项国际调查发现，专家们在主胰管/混合型导管内乳头状黏液性肿瘤的治疗策略上缺乏临床相关的共识。需要进行长期随访研究，包括主胰管/混合型导管内乳头状黏液性肿瘤部分和全胰切除术后的生活质量。
