Trends in Cyst Size of Resected Intraductal Papillary Mucinous Neoplasms Over Time-Has the Evolution of the International Association of Pancreatology (IAP) Guidelines Impacted Surgical Thresholds.
International consensus guidelines have informed the management of intraductal papillary mucinous neoplasms (IPMNs) and introduced high risk stigmata and worrisome features that risk stratify lesions beyond only cyst size. In this study, we sought to understand whether these clinical considerations have impacted surgical selection criteria at United States hospitals.
The National Cancer Database (2004-2021) was queried to identify all patients that underwent resection for non-invasive and invasive IPMNs. Patients with missing cyst size data were excluded. The cohort was divided into time periods reflecting the succession of IAP guidelines: Pre-Fukuoka (2004-2011), Fukuoka (2012-2016), Revised Fukuoka (2017-2021).
Of 3,580 resected IPMNs, invasive pathology was identified in 44% of all lesions, increasing to 48% when applying the Revised Fukuoka guidelines (Fukuoka 40%, Pre-Fukuoka 43%, p<0.001). While median cyst size of all resected IPMNs remained similar throughout the three eras, median size of non-invasive lesions progressively increased (2.6cm to 3.0cm, p=0.001), and that of invasive IPMNs decreased over time (3.1cm to 2.8cm, p<0.001). The proportion of resected non-invasive cysts ≥3cm increased over time (46%-52%-55%, p<0.001); however, the opposite was true for invasive lesions (57%-50%-48%, p=0.013). These trends were agnostic to hospital type (academic vs. non-academic), and non-academic hospitals had a greater proportion of non-invasive IPMNs ≥3cm (55% vs. 49%, p=0.026).
The size of resected noninvasive IPMNs has increased over time, whereas the size of invasive lesions has progressively decreased. This trend may reflect improved, guideline concordant recognition of malignant risk features, including reduced reliance on cyst size alone.
The National Cancer Database (2004-2021) was queried to identify all patients that underwent resection for non-invasive and invasive IPMNs. Patients with missing cyst size data were excluded. The cohort was divided into time periods reflecting the succession of IAP guidelines: Pre-Fukuoka (2004-2011), Fukuoka (2012-2016), Revised Fukuoka (2017-2021).
Of 3,580 resected IPMNs, invasive pathology was identified in 44% of all lesions, increasing to 48% when applying the Revised Fukuoka guidelines (Fukuoka 40%, Pre-Fukuoka 43%, p<0.001). While median cyst size of all resected IPMNs remained similar throughout the three eras, median size of non-invasive lesions progressively increased (2.6cm to 3.0cm, p=0.001), and that of invasive IPMNs decreased over time (3.1cm to 2.8cm, p<0.001). The proportion of resected non-invasive cysts ≥3cm increased over time (46%-52%-55%, p<0.001); however, the opposite was true for invasive lesions (57%-50%-48%, p=0.013). These trends were agnostic to hospital type (academic vs. non-academic), and non-academic hospitals had a greater proportion of non-invasive IPMNs ≥3cm (55% vs. 49%, p=0.026).
The size of resected noninvasive IPMNs has increased over time, whereas the size of invasive lesions has progressively decreased. This trend may reflect improved, guideline concordant recognition of malignant risk features, including reduced reliance on cyst size alone.
Authors
Wong Wong, Pollini Pollini, Hernandez Hernandez, Todeschini Todeschini, Maker Maker
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