Mavani Parit T, Sok Caitlin, Eng Nina, Marra Angelo, Foroutani Laleh, Alseidi Adnan, Hariri Hussein, Wilson Gregory, Ahmad Syed A, Scoggins Charles, Hester Caitlin, Datta Jashodeep, Merchant Nipun, LeCompte Michael, Kim Hong Jin, Sigler Gregory, Zafar Nabeel, Weber Sharon, Prela Orjola, Carpizo Darren, Kasting Christina, Fields Ryan, Sarmiento Juan M, Russell Maria C, Shah Mihir M, Maithel Shishir K, Kooby David A
From the Department of Surgery, Emory University School of Medicine, Atlanta, GA (Mavani, Sok, Sarmiento, Russell, Shah, Maithel, Kooby).
Department of Surgery, Pennsylvania State University School of Medicine, Hershey, PA (Eng).
J Am Coll Surg. 2025 Apr 1;240(4):392-402. doi: 10.1097/XCS.0000000000001289. Epub 2025 Mar 17.
Pancreaticoduodenectomy (PD) may occasionally be indicated for complete removal of periampullary (duodenal and ampullary) adenomas (PAs). As compared with malignant indications, PD for benign or premalignant disease is often associated with increased morbidity. Although the Spigelman classification assesses malignancy risk for familial adenomatous polyposis (FAP)-related duodenal adenomas, no malignancy risk score (MRS) exists for non-FAP-related PAs. We developed an MRS for non-FAP-related PAs undergoing PD to weigh the risk of malignancy and postoperative morbidity.
We retrospectively analyzed patients with non-FAP-related PA who underwent PD at 8 institutions (2010 to 2022). Patient and lesion factors associated with final malignant pathology were identified using multivariable logistic regression to create MRS. Postoperative complications were assessed according to MRS.
Of 127 patients, 59 (46.5%) had evidence of malignancy on final pathology. The odds of malignancy were higher in patients aged 65 years or older (odds ratio [OR] 3.2, p = 0.01), having bile duct 9 mm or more (OR 3.3, p = 0.009), having preoperative symptoms (OR 7.7, p = 0.002), and having high-grade dysplasia (OR 7.5, p < 0.001). A MRS was derived ranging from 0 to 6: age 65 years or older = 1, bile duct 9 mm or more = 1, symptomatic = 2, and high-grade dysplasia = 2. Patients were stratified into low-risk (MRS 1 to 2, n = 26), intermediate-risk (MRS 3 to 4, n = 59), and high-risk groups (MRS 5 to 6, n = 26), with malignancy rates increasing with MRS (10.3%, 44.1%, and 88.2%, p < 0.001). Patients in the no- or low-risk group (MRS 0 to 2) had higher odds of major postoperative complications compared with patients in the intermediate- or high-risk group (MRS 3 or higher, OR 2.9, p = 0.047).
This novel MRS stratifies the risk of malignancy in non-FAP-related PAs managed with PD. This score can be used to counsel patients who may require PD for complete tumor removal about their risk of harboring malignancy and their risk of major postoperative complications.
胰十二指肠切除术（PD）偶尔用于完全切除壶腹周围（十二指肠和壶腹）腺瘤（PA）。与恶性疾病适应证相比，用于良性或癌前疾病的PD通常与发病率增加相关。尽管Spigelman分类法评估了家族性腺瘤性息肉病（FAP）相关十二指肠腺瘤的恶性风险，但对于非FAP相关的PA不存在恶性风险评分（MRS）。我们开发了一种用于接受PD的非FAP相关PA的MRS，以权衡恶性风险和术后发病率。
我们回顾性分析了8家机构（2010年至2022年）接受PD的非FAP相关PA患者。使用多变量逻辑回归确定与最终恶性病理相关的患者和病变因素，以创建MRS。根据MRS评估术后并发症。
127例患者中，59例（46.5%）最终病理显示有恶性证据。65岁及以上患者的恶性几率更高（优势比[OR]3.2，p = 0.01），胆管直径9mm及以上（OR 3.3，p = 0.009），有术前症状（OR 7.7，p = 0.002），以及有高级别异型增生（OR 7.5，p < 0.001）。得出的MRS范围为0至6：65岁及以上 = 1，胆管9mm及以上 = 1，有症状 = 2，高级别异型增生 = 2。患者被分为低风险组（MRS 1至2，n = 26）、中风险组（MRS 3至4，n = 59）和高风险组（MRS 5至6，n = 26），恶性率随MRS增加（10.3%、44.1%和88.2%，p < 0.001）。无风险或低风险组（MRS 0至2）的患者与中风险或高风险组（MRS 3或更高）的患者相比，术后主要并发症的几率更高（OR 2.9，p = 0.047）。
这种新的MRS对接受PD治疗的非FAP相关PA的恶性风险进行了分层。该评分可用于为可能需要PD以完全切除肿瘤的患者提供咨询，告知他们患恶性肿瘤的风险以及术后主要并发症的风险。
