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Impact of surgery and surveillance in the management of branch duct intraductal papillary mucinous neoplasms of the pancreas according to Fukuoka guidelines: the Bologna experience

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Abstract

The objective of the study was to evaluate the Fukuoka guidelines in indicating the proper management for recognising the risk factors of malignancy. Data of patients with branch duct intraductal papillary mucinous neoplasms who underwent pancreatic resection or surveillance according to the Fukuoka risk parameters were collected in a prospective database. The clinical outcome (development of pancreatic cancer, overall and disease-specific survival) and pathological results were evaluated in all patients and in resected cases, respectively. The data of 197 patients were collected: 23 primarily resected and 174 primarily followed. Of the latter, 16 were secondarily resected. Among the patients resected, 21 (53.9%) showed diagnosis of in situ or invasive carcinoma and only contrast-enhancing mural nodules were significantly related to malignancy (P = 0.002), with a DOR of 3.3 and an LH+ of 2.2. Development of pancreatic cancer was shown in ten (5.7%) of the patients primarily followed. The overall survival and disease-specific survival were similar between patients primarily followed and primarily resected. It seems reasonable to suggest that a branch duct intraductal papillary mucinous neoplasm should be treated as a benign and indolent disease that is rarely malignant. Enhancing mural nodules represent the best indicator for surgery.

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Authors and Affiliations

  1. Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, Malpighi Hospital, University of Bologna, Via Massarenti n.9, 40138, Bologna, Italy

    Riccardo Casadei, Claudio Ricci, Giovanni Taffurelli, Carlo Alberto Pacilio, Marina Migliori & Francesco Minni

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  1. Riccardo Casadei
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  2. Claudio Ricci
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  3. Giovanni Taffurelli
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  4. Carlo Alberto Pacilio
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  5. Marina Migliori
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  6. Francesco Minni
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All the authors have participated sufficiently in the work according the guidelines of the International Committee of Medical Journal Editors (ICMJE).

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Correspondence to Riccardo Casadei.

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No funding were received for the study.

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There is no commercial interest, financial source or material support to disclose.

Conflict of interest

Riccardo Casadei and the other co-authors decalre that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in the study involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinky declaration and its later amendments or comparable ethical standards.

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Iinformed consent was obtained from all individual participants included in the study.

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Casadei, R., Ricci, C., Taffurelli, G. et al. Impact of surgery and surveillance in the management of branch duct intraductal papillary mucinous neoplasms of the pancreas according to Fukuoka guidelines: the Bologna experience. Updates Surg 70, 47–55 (2018). https://doi.org/10.1007/s13304-017-0471-7

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  • DOI: https://doi.org/10.1007/s13304-017-0471-7

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