Targarona Javier, Legua-Pérez Sebastián, Coayla Guillermo, Roman Gilbert, Morales Eduardo, Venturo Alexia, Rivero Luis, Rivas Diego, Carrasco Roberto
Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú.
Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú; Departamento de Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú.
Rev Gastroenterol Peru. 2025 Apr-Jun;45(2):120-130.
The objective of this study is to analyze the main clinical and epidemiological factors related to the risk of malignancy in intraductal papillary mucinous neoplasia of the pancreas in a cohort of patients seen at a referral clinic in Lima, Peru, based on the criteria of the IAP/Fukuoka guidelines.
This is a retrospective cohort study, which evaluated patients diagnosed with pancreatic IPMN from December 2015 to August 2023. They were classified according to involvement of the main branch, side branch, and mixed pancreatic ducts, considering aspects such as high-risk stigmata, concerning factors, age, sex, medical history, and others.
A total of 253 patients with pancreatic IPMN were included, 71.2% had side branch IPMNs, 9% had main branch IPMNs, and 19.8% were mixed. 49 patients (19.4%) underwent surgery at the time of diagnosis due to high-risk stigmata or factors concerning for malignancy. The remaining 204 patients were enrolled in a follow-up program for a mean of 31 months (6-100 months). During follow-up, a decision was made to operate on 38 of them. Of the 87 patients operated on, 36.7% presented invasive cancer and 11.4% high-grade dysplasia. The presence of a mural nodule greater than 5 mm increased the probability of malignancy 11.21 times; jaundice increased the risk of malignancy by more than 5 times. Wirsung duct dilation between 5 and 9.9 mm had a prevalence ratio (PR) of 2.12, and for dilation greater than 10 mm, a PR of 4.69 (p<0.05). The presence of three or more risk factors showed a PR of 6.77 in the bivariate analysis, and an adjusted prevalence ratio (aPR) of 17.11 in the multivariate analysis.
Diagnosis and periodic monitoring of IPMNs allow for early detection of potentially malignant lesions, allowing for timely, often curative, surgery. However, there is currently no reliable way to diagnose and identify which cystic lesions already present or are likely to present malignant characteristics, thus providing clear indications for surgical intervention in these patients.
本研究的目的是根据国际胰腺病协会/福冈指南的标准，分析秘鲁利马一家转诊诊所的一组患者中，与胰腺导管内乳头状黏液性肿瘤恶性风险相关的主要临床和流行病学因素。
这是一项回顾性队列研究，评估了2015年12月至2023年8月期间被诊断为胰腺导管内乳头状黏液性肿瘤的患者。根据主胰管、分支胰管和混合性胰管的受累情况进行分类，同时考虑高危特征、相关因素、年龄、性别、病史等方面。
共纳入253例胰腺导管内乳头状黏液性肿瘤患者，其中71.2%为分支型导管内乳头状黏液性肿瘤，9%为主胰管型导管内乳头状黏液性肿瘤，19.8%为混合型。49例患者（19.4%）因高危特征或恶性相关因素在诊断时接受了手术。其余204例患者纳入随访计划，平均随访31个月（6 - 100个月）。随访期间，其中38例患者决定接受手术。在87例接受手术的患者中，36.7%出现浸润性癌，11.4%出现高级别上皮内瘤变。存在大于5 mm的壁结节使恶性概率增加11.21倍；黄疸使恶性风险增加5倍以上。主胰管直径在5至9.9 mm之间的扩张患病率比（PR）为2.12，直径大于10 mm时，PR为4.69（p<0.05）。在双变量分析中，存在三个或更多风险因素的PR为6.77，在多变量分析中调整患病率比（aPR）为17.11。
对导管内乳头状黏液性肿瘤的诊断和定期监测有助于早期发现潜在恶性病变，从而实现及时且通常可治愈的手术。然而，目前尚无可靠方法诊断和识别哪些囊性病变已经存在或可能具有恶性特征，因此无法为这些患者的手术干预提供明确指征。
