Surgery may be better than observation for pancreatic branch duct IPMNs with ‘worrisome features’
medwireNews: Early resection should be considered for patients with pancreatic branch duct intraductal papillary mucinous neoplasms (IPMNs) with “worrisome features,” say US researchers who found that surgery compared favorably with surveillance in a statistical modeling analysis.
Using a comparative effectiveness Markov model, they calculated that a 65-year-old patient with an incidentally detected branch duct IPMN at least 3 cm in size, with radiographic features such as thickened, enhancing cyst walls and lymphadenopathy, would gain 11.63 quality-adjusted life–years with upfront surgery over 2 decades of follow-up versus 11.06 with surveillance.
However, Victor Zaydfudim and co-workers, from the University of Virginia School of Medicine in Charlottesville, caution that patient, surgeon, and tumor factors must be carefully considered as the model results were contingent on specific criteria, such as a life expectancy of 18 years or more and surgical mortality of less than 4.3%.
In a commentary accompanying the research in JAMA Surgery, Salila Hashmi (Emory University, Atlanta, Georgia, USA) and David Kooby (Emory Saint Joseph’s Hospital, Atlanta) say that despite limitations inherent to predictive statistical models – such as the tendency to oversimplification – the findings “can serve as template for surgical recommendations for a challenging group of patients who face relatively risky, life-altering operations for a disease process with uncertain malignant potential.”
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