Litchinko Alexis, Kobayashi Kosuke, Halkic Nermin
Department of Surgery, Division of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Ann Med Surg (Lond). 2020 Oct 20;60:110-114. doi: 10.1016/j.amsu.2020.10.028. eCollection 2020 Dec.
Intraductal papillary mucinous neoplasm (IPMN) is a 21st century concept and its management is still controversial. Strong guidelines suggest that surgery is the safest way to prevent malignant evolution. Though the risk of neoplasia is still debated, high-morbidity and mortality surgery must be proposed for high-risk patients to prevent malignant and most likely fatal pancreatic neoplasia.
The aim of this study was to analyze histological results of patients who underwent operation for IPMN under the Sendai and Fukuoka guidelines. From January 2005 to August 2016, 491 consecutive patients who underwent pancreatic resection in Lausanne University Hospital were analyzed, including 18 IPMN with surgical indication according to the Sendai and Fukuoka criteria.
Thirteen (68.4%) patients had benign histopathology after surgery (the non-malignant group). Of the patients with malignant pathology, four (21%) had high-grade dysplasia and two (20.1%) had invasive carcinoma (the malignant group). The median patient age ( = 0.011) and preoperative Carbohydrate Antigen 19-9 (CA19-9) ( = 0.030) were significantly higher in the malignant group than in the non-malignant group.
The use of the current criteria is adequate, but it may be resulting in surgery on excessive numbers of patients with IPMN. A modern decision-making strategy should be based on clinical features, precise imaging data, and biological markers.
导管内乳头状黏液性肿瘤（IPMN）是21世纪提出的概念，其治疗方法仍存在争议。强有力的指南表明，手术是预防恶性进展的最安全方法。尽管肿瘤形成风险仍存在争议，但对于高危患者必须建议进行高发病率和死亡率的手术，以预防恶性且极有可能致命的胰腺肿瘤。
本研究的目的是分析在仙台和福冈指南下接受IPMN手术患者的组织学结果。对2005年1月至2016年8月在洛桑大学医院接受胰腺切除术的491例连续患者进行分析，其中包括18例根据仙台和福冈标准有手术指征的IPMN患者。
13例（68.4%）患者术后组织病理学为良性（非恶性组）。在有恶性病理的患者中，4例（21%）有高级别异型增生，2例（20.1%）有浸润性癌（恶性组）。恶性组患者的中位年龄（P = 0.011）和术前糖类抗原19-9（CA19-9）水平（P = 0.030）显著高于非恶性组。
目前标准的使用是恰当的，但可能导致对过多IPMN患者进行手术。现代决策策略应基于临床特征、精确的影像学数据和生物学标志物。
