TY - JOUR
T1 - Risk of pancreatic malignancy and mortality in branch-duct IPMNs undergoing surveillance
T2 - A systematic review and meta-analysis
AU - Crippa, Stefano
AU - Capurso, Gabriele
AU - Cammà, Calogero
AU - Fave, Gianfranco Delle
AU - Castillo, Carlos Fernández del
AU - Falconi, Massimo
PY - 2015/9/22
Y1 - 2015/9/22
N2 - Background: Safety of non-operative management for low-risk branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is debated. Aim: To perform a systematic review/meta-analysis to determine their risk of developing pancreatic malignancy and of pancreatic malignancy-related deaths. Methods: A MEDLINE search was performed and methodology was based on PRISMA statement. Incidence rates of overall pancreatic malignancy, malignant BD-IPMN, IPMN-distinct PDAC, and of pancreatic malignancy-related death rates were calculated by dividing the total number of events by the total number of person-years (pyrs) of follow-up. Heterogeneity was determined by I 2 statistic. Results: 20 studies including 2177 patients were included. Mean follow-up ranged from 29.3 to 76.7 months. Overall, 82 patients (3.7%) developed a pancreatic malignancy with a pooled estimate rate of 0.007/pyrs (I 2 =32.8%). The pooled estimate rate of malignant IPMN was 0.004/pyrs (I 2 =40.8%), and the pooled estimate rate of distinct PDAC 0.002/pyrs (I 2 =0%). The rate of death due to pancreatic malignancy during follow-up was 0.9%, with an overall pooled estimate rate of death of 0.002/pyrs (I 2 =0%). Conclusion: Non-operative management of low-risk BD-IPMN is safe, with a very low risk of malignant transformation of IPMN and of distinct PDAC. The rate of pancreatic malignancy-related mortality is low, particularly when compared with the mortality of pancreatic surgery.
AB - Background: Safety of non-operative management for low-risk branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) is debated. Aim: To perform a systematic review/meta-analysis to determine their risk of developing pancreatic malignancy and of pancreatic malignancy-related deaths. Methods: A MEDLINE search was performed and methodology was based on PRISMA statement. Incidence rates of overall pancreatic malignancy, malignant BD-IPMN, IPMN-distinct PDAC, and of pancreatic malignancy-related death rates were calculated by dividing the total number of events by the total number of person-years (pyrs) of follow-up. Heterogeneity was determined by I 2 statistic. Results: 20 studies including 2177 patients were included. Mean follow-up ranged from 29.3 to 76.7 months. Overall, 82 patients (3.7%) developed a pancreatic malignancy with a pooled estimate rate of 0.007/pyrs (I 2 =32.8%). The pooled estimate rate of malignant IPMN was 0.004/pyrs (I 2 =40.8%), and the pooled estimate rate of distinct PDAC 0.002/pyrs (I 2 =0%). The rate of death due to pancreatic malignancy during follow-up was 0.9%, with an overall pooled estimate rate of death of 0.002/pyrs (I 2 =0%). Conclusion: Non-operative management of low-risk BD-IPMN is safe, with a very low risk of malignant transformation of IPMN and of distinct PDAC. The rate of pancreatic malignancy-related mortality is low, particularly when compared with the mortality of pancreatic surgery.
KW - Follow-up
KW - Non-operative management
KW - Pancreatectomy
KW - Pancreatic cancer
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U2 - 10.1016/j.dld.2016.02.003
DO - 10.1016/j.dld.2016.02.003
M3 - Article
AN - SCOPUS:84960982053
JO - Digestive and Liver Disease
JF - Digestive and Liver Disease
SN - 1590-8658
ER -