An ACS NSQIP Analysis of Surgical Outcomes for Intraductal Papillary Mucinous Neoplasms of the Pancreas
*Samuel M Miller, *Joseph T King, *Vanita Ahuja, Ronald R Salem, John W Kunstman
Yale University School of Medicine, New Haven, CT
Objective: Surgery is preferred for pancreatic intraductal papillary mucinous neoplasms (IPMN) containing invasive disease or high-grade dysplasia; however, determining this diagnosis pre-operatively is challenging. We examine evolving national trends in IPMN management and contrast outcomes of patients undergoing pancreatectomy for IPMN versus non-IPMN indications. Design: Retrospective cohort Setting: NSQIP-participating hospitals Patients: Pancreatectomy cases were identified from the 2014-2018 NSQIP dataset. Cohorts were delineated via pathologic categories as IPMN with invasive disease (IPMN-INV), IPMN with benign/non-invasive disease (IPMN-B), and non-IPMN pathology (OTHER). Interventions: N/A Main Outcome Measure: Ratio of IPMN-INV to IPMN-B pathology and major postoperative morbidity in aggregate IPMN versus OTHER. Additional outcomes included mortality, clinically-relevant pancreatic fistula (CR-PF), and length of stay (LOS). Results: 31,965 subjects were identified; 3,112 (9.7%) cases were performed for IPMN with IPMN-INV found in 852 (27.4%). IPMN patients were older (67.4 versus 63.0 years, p<0.001) and underwent fewer pancreaticoduodenectomies (53.9% versus 62.6%, p<0.001) or vascular resections (4.8% versus 14.9%, p<0.001) compared to OTHER patients. Those with IPMN experienced fewer major complications (31.0% versus 39.9%, p<0.001) but similar rates of CR-PF (12.7% versus 13.8%, p=0.09) than the OTHER cohort. 30-day mortality was lower (0.8% versus 1.5%, p<0.001) and LOS was shorter (8.8 vs 9.3 days, p<0.001) for IPMN compared to OTHER patients. Conclusions: Among patients undergoing pancreatectomy for IPMN, the low incidence of IPMN-INV suggests improved guidelines or biomarkers are required to better select candidates and minimize unneeded resections. Despite this, outcomes for patients undergoing pancreatectomy for IPMN compare favorably to those with non-IPMN indications.
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