Detailed Abstract
[Plenary Session - Biliary & Pancreas (Biliary Disease/Surgery)]
[PL-S2] Validation of the International Association of Pancreatology (IAP) 2023 Guidelines on Resection Strategies for Branch-Duct (BD) Or Mixed-type Intraductal Papillary Mucinous Neoplasms (IPMN)
Hye-Sol JUNG 1, Youngmin HAN 1, Young Jae CHO 1, Yoonsoo CHAE 1, Go Won CHOI 1, Won-Gun YUN 1, Mirang LEE 1, Wooil KWON 1, Jin-Young JANG 1
1 Department of Surgery And Cancer Research Institute, Seoul National University Hospital, REPUBLIC OF KOREA
Background : The IAP guideline for management of IPMN has been revised in 2023. Solid portion, positive cytology was added to high-risk stigmata (HRS), and new onset or aggravated diabetes mellitus was added to worrisome feature (WF). In previous guideline (2017), for BD-IPMN presenting worrisome features, surgery was recommended if there were positive EUS findings. In this revision, surgical indication of BD-IPMN has been changed to include the presence of at least two WFs. This study aims to validate treatment strategies of the revised IAP 2023 guideline compared to IAP 2017 and European (2018) guidelines.
Methods : A total of 556 patients who underwent resection for pathologically confirmed BD or mixed-type IPMN from 2013 to 2023 were retrospectively reviewed. Surgical indication of each guideline is as follows: IAP 2017; HRS, EUS-positive, size ≥ 3cm with young, fit for surgery; IAP 2023; HRS, WFs ≥2; European; absolute indication, relative indication ≥1.
Results : There were 473, 451, 538 patients who met the surgical indication of IAP 2017, IAP 2023, and European guidelines. Malignant IPMN was observed in 229 (41.2%) patients (high-grade dysplasia 98, invasive IPMN 131). Resection strategy of IAP 2023 guideline provided a higher specificity (29.1 vs 22.3%; p=0.046), negative predictive value (NPV) (88.8 vs 78.5%; p=0.048) compared to IAP 2017 guideline. It showed a higher specificity (29.1 vs 5.5%; p<0.001) and accuracy (56.1 vs 44.4%; p<0.001) compared to European guideline.
Conclusions : IAP 2023 guidelines present better specificity, NPV compared to IAP 2017 and European guidelines. The revised 2023 guideline is clinically useful to reduce unnecessary pancreatectomies.
Methods : A total of 556 patients who underwent resection for pathologically confirmed BD or mixed-type IPMN from 2013 to 2023 were retrospectively reviewed. Surgical indication of each guideline is as follows: IAP 2017; HRS, EUS-positive, size ≥ 3cm with young, fit for surgery; IAP 2023; HRS, WFs ≥2; European; absolute indication, relative indication ≥1.
Results : There were 473, 451, 538 patients who met the surgical indication of IAP 2017, IAP 2023, and European guidelines. Malignant IPMN was observed in 229 (41.2%) patients (high-grade dysplasia 98, invasive IPMN 131). Resection strategy of IAP 2023 guideline provided a higher specificity (29.1 vs 22.3%; p=0.046), negative predictive value (NPV) (88.8 vs 78.5%; p=0.048) compared to IAP 2017 guideline. It showed a higher specificity (29.1 vs 5.5%; p<0.001) and accuracy (56.1 vs 44.4%; p<0.001) compared to European guideline.
Conclusions : IAP 2023 guidelines present better specificity, NPV compared to IAP 2017 and European guidelines. The revised 2023 guideline is clinically useful to reduce unnecessary pancreatectomies.
SESSION
Plenary Session
Room A 3/23/2024 11:20 AM - 12:20 PM