Clinical Outcomes of Intraductal Papillary Mucinous Neoplasms With Dilatation of the Main Pancreatic Duct

Tsuyoshi Hamada, Hiroki Oyama, Yousuke Nakai, Shuichi Tange, Junichi Arita, Ryunosuke Hakuta, Hideaki Ijichi, Kazunaga Ishigaki, Sachiko Kanai, Yoshikuni Kawaguchi, Hirofumi Kogure, Suguru Mizuno, Kei Saito, Tomotaka Saito, Tatsuya Sato, Tatsunori Suzuki, Naminatsu Takahara, Mariko Tanaka, Keisuke Tateishi, Tetsuo UshikuKiyoshi Hasegawa, Mitsuhiro Fujishiro

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background & Aims: Dilatation of the main pancreatic duct (MPD) has been a surgical indication for intraductal papillary mucinous neoplasms (IPMNs). Few studies have investigated long-term outcomes of IPMNs with MPD dilatation. Methods: Among 3610 patients diagnosed with pancreatic cysts between 1994 and 2021, we identified 2829 IPMN patients, including 282 patients with MPD ≥5 mm, and examined short-term (≤6 months) and long-term risks of pancreatic carcinoma. Utilizing competing risks proportional hazards models, we estimated subdistribution hazard ratios for incidence of pancreatic carcinoma with adjustment for potential confounders. Results: In analyses of short-term outcomes of the 282 patients with MPD dilatation, 72 (26%) patients were diagnosed with pancreatic carcinoma based on surgical or nonsurgical exploration. During long-term follow-up of 168 patients, we documented 24 (14%) patients diagnosed with pancreatic carcinoma (18 with IPMN-derived carcinoma and 6 with concomitant ductal adenocarcinoma). The patients with the MPD = 5-9.9 mm had cumulative incidence rates of pancreatic carcinoma diagnosis of 8.1% (95% confidence interval [CI], 4.3%–13.5%) and 10.0% (95% CI, 5.5%–15.9%) at 2 and 5 years, respectively; and the patients with the MPD ≥10 mm had the corresponding rates of 16.0% (95% CI, 3.6–36.5%) and 33.3% (95% CI, 10.3%–58.8%). The multivariable subdistribution hazard ratios were 2.78 (95% CI, 1.57–4.90) and 7.00 (95% CI, 2.58–19.0) for the MPD = 5-9.9 mm and ≥10 mm (vs <5 mm), respectively. Conclusions: IPMNs with MPD dilatation at baseline were associated with higher prevalence and incidence of pancreatic carcinoma compared with IPMNs with no MPD dilatation.

Original languageEnglish
Pages (from-to)1792-1801.e3
JournalClinical Gastroenterology and Hepatology
Volume21
Issue number7
DOIs
Publication statusPublished - Jul 2023
Externally publishedYes

Keywords

  • Carcinogenesis
  • Cohort Studies
  • Pancreatic Neoplasms
  • Risk Factors

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