BACKGROUND Little is known about the prognostic significance of pancreatic duct (PD) dilation following pancreatoduodenectomy for intraductal papillary mucinous neoplasms (IPMN). Although PD dilation is typically the hallmark radiographic feature of IPMN, other causes of PD dilation exist, including anastomotic stricture, pancreatitis, senescence, and postsurgical passive dilation. Therefore, PD dilation after pancreatoduodenectomy for IPMN represents a diagnostic and management dilemma. The purpose of this study was to evaluate the significance of PD dilation after pancreatoduodenectomy for noninvasive IPMN. METHODS All patients who underwent pancreatoduodenectomy for noninvasive IPMN at nine pancreatic academic centers between 2013 and 2018 were included. Variables were entered prospectively into institutional databases and retrospectively reviewed for the purpose of this study. Dilation of the PD remnant was defined as a duct diameter of ≥5 mm, according to international guidelines. RESULTS Four-hundred and eighty-one patients were included in this study. The mean age of the patients was 66 years (range 30-90). Patients were surveilled for a median of 4.5 (+/-2.3; max 10.6) years. During follow-up, 132 patients (27.4%) developed PD dilation in the remnant tissue after a median of 3.3 years. Multivariable analysis demonstrated that older age at the time of pancreatoduodenectomy (P=0.01) and longer surveillance duration (P=0.002) were predictors of PD dilation. Interestingly, neither the pathological IPMN subtype (branch-duct vs. main duct/mixed, P=0.96) nor the preoperative PD diameter (P=0.14) was associated with an increased risk of PD dilation in the remnant. During follow-up, IPMN recurrence was suspected in the remaining 72 patients (18.4%), solely because of ductal dilation on cross-sectional imaging in 97% (70/72). Completion pancreatectomy was performed in only 16 patients (3.3%), of whom only four (0.8%) had invasive carcinoma. Three of these four patients had high-grade dysplasia in the original pancreatoduodenectomy specimen, whereas only one had a low-grade dysplastic lesion initially. On multivariable analysis, no variable was predictive of IPMN recurrence in the remnant. CONCLUSIONS New main duct dilation in the pancreatic remnant after pancreatoduodenectomy for IPMN is common, occurring in 27% of the patients. The duration of surveillance is the main factor associated with remnant PD dilation, suggesting that this is likely a physiologic phenomenon. Although recurrence of IPMN in the remnant is often suspected, only 0.8% of patients develop an invasive carcinoma in the pancreatic remnant requiring completion pancreatectomy.

中文翻译：

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非侵入性导管内乳头状粘液性肿瘤胰十二指肠切除术后残余胰管的自然史：来自国际联盟的结果。


背景 对于胰十二指肠切除术后胰管（PD）扩张对导管内乳头状粘液性肿瘤（IPMN）的预后意义知之甚少。虽然 PD 扩张通常是 IPMN 的标志性放射学特征，但 PD 扩张的其他原因也存在，包括吻合口狭窄、胰腺炎、衰老和术后被动扩张。因此，IPMN 胰十二指肠切除术后的 PD 扩张代表了诊断和治疗的困境。本研究的目的是评估胰十二指肠切除术后 PD 扩张对无创 IPMN 的意义。方法纳入 2013 年至 2018 年间在 9 个胰腺学术中心接受胰十二指肠切除术以进行无创 IPMN 的所有患者。为了本研究的目的，变量被前瞻性地输入机构数据库并进行回顾性审查。根据国际指南，PD 残余扩张定义为导管直径≥5 毫米。结果 本研究纳入了 481 名患者。患者的平均年龄为 66 岁（范围 30-90 岁）。对患者的监测时间中位数为 4.5（+/-2.3；最长 10.6）年。在随访期间，132 名患者 (27.4%) 在中位 3.3 年后出现残余组织 PD 扩张。多变量分析表明，胰十二指肠切除术时的年龄较大（P=0.01）和较长的监测时间（P=0.002）是PD扩张的预测因素。有趣的是，病理性 IPMN 亚型（分支导管与主导管/混合，P=0.96）和术前 PD 直径（P=0.14）均与残余 PD 扩张风险增加无关。在随访期间，其余 72 名患者怀疑 IPMN 复发（18.4%），仅因为横截面成像上的导管扩张（97% (70/72)）。仅 16 名患者 (3.3%) 接受了完整的胰腺切除术，其中只有 4 名患者 (0.8%) 患有浸润性癌。这四名患者中的三名在最初的胰十二指肠切除标本中具有高度不典型增生，而只有一名患者最初具有低度不典型增生病变。在多变量分析中，没有变量可以预测残余物中 IPMN 的复发。结论 IPMN 胰十二指肠切除术后残余胰腺出现新的主导管扩张很常见，发生率为 27%。监测持续时间是与残余 PD 扩张相关的主要因素，表明这可能是一种生理现象。尽管经常怀疑残余胰腺中 IPMN 复发，但只有 0.8% 的患者在残余胰腺中发展为浸润性癌，需要完成胰腺切除术。