New Surgical Criteria for Intraductal Papillary Mucinous Neoplasm Based on the Age-Adjusted Charlson Comorbidity Index Values and Presence of Solid Component
Hiroyuki Hasegawa,
Mitsuharu Fukasawa,
Shinichi Takano,
Satoshi Kawakami,
Natsuhiko Kuratomi,
Shota Harai,
Dai Yoshimura,
Naoto Imagawa,
Tetsuya Okuwaki,
Toru Kuno,
Yuichiro Suzuki,
Takashi Yoshida,
Shoji Kobayashi,
Mitsuaki Sato,
Shinya Maekawa,
Naohiro Hosomura,
Hiromichi Kawaida,
Daisuke Ichikawa,
Nobuyuki Enomoto
Affiliations
Hiroyuki Hasegawa
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Mitsuharu Fukasawa
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Shinichi Takano
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Satoshi Kawakami
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Natsuhiko Kuratomi
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Shota Harai
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Dai Yoshimura
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Naoto Imagawa
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Tetsuya Okuwaki
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Toru Kuno
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Yuichiro Suzuki
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Takashi Yoshida
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Shoji Kobayashi
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Mitsuaki Sato
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Shinya Maekawa
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Naohiro Hosomura
Department of Surgery, Japan Community Health Care Organization, Yamanashi Hospital, 3-11-16, Asahi, Kofu 400-0025, Yamanashi, Japan
Hiromichi Kawaida
First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Daisuke Ichikawa
First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Nobuyuki Enomoto
Department of Gastroenterology, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo 409-3898, Yamanashi, Japan
Objectives: The present study aimed to validate the new international guidelines for IPMN and determine the surgical criteria for patients with IPMN exhibiting high-risk stigmata (HRS). Methods: We enrolled 115 IPMN patients exhibiting HRS who were diagnosed between 2004 and 2021. Of the 115 patients, 79 underwent surgery (surgical group) and 36 did not undergo surgery (non-surgical group). The overall survival (OS) of each group was compared, and multivariate analysis was performed to identify factors associated with OS. Results: There was no significant difference in the estimated 5-year OS in the surgical and non-surgical groups (67% vs. 74%; p = 0.75). The presence of a solid component (SC) (hazard ratio [HR], 6.92; 95% confidence interval [CI], 3.30–14.5) and a high score of age-adjusted Charlson comorbidity index (ACCI) (≥5) (HR, 2.27; 95% CI, 1.11–4.64) were independent predictors of poor OS. In the presence of an SC, the surgical group had a significantly better OS than the non-surgical group (estimated 5-year OS, 38% vs. 18%; p = 0.031). In the absence of an SC, the prognosis of patients with a high ACCI was significantly poorer than those with a low ACCI in the surgical group (estimated 5-year OS, 59% vs. 93%; p = 0.005). Conclusions: An SC and a high ACCI are important prognostic factors in IPMN patients exhibiting HRS. Thus, patients with an SC should undergo surgical resection. However, conservative management may be the optimal treatment in patients without an SC and with a high ACCI.
