Brief Article
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World J Gastroenterol. Mar 7, 2013; 19(9): 1451-1457
Published online Mar 7, 2013. doi: 10.3748/wjg.v19.i9.1451
Decision making for pancreatic resection in patients with intraductal papillary mucinous neoplasms
Bin Xu, Wei-Xing Ding, Da-Yong Jin, Dan-Song Wang, Wen-Hui Lou
Bin Xu, Wei-Xing Ding, Department of General Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China
Da-Yong Jin, Dan-Song Wang, Wen-Hui Lou, Department of General Surgery, Zhong Shan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Xu B and Ding WX contributed equally to this work; Xu B and Lou WH designed the research; Xu B, Ding WX, Jin DY, Wang DS and Lou WH performed the research; Ding WX, Jin DY and Lou WH analyzed the data; Xu B wrote the paper.
Supported by The National Natural Science Foundation of China, No. 81001007; the Program for Young Excellent Talents in Tongji University, No. 2008KJ060; and Youth Fund of the Shanghai Tenth People’s Hospital, No. 10RQ105
Correspondence to: Wen-Hui Lou, MD, Department of General Surgery, Zhong Shan Hospital, Fudan University, Shanghai 200032, China. wenhuilou@yahoo.com.cn
Telephone: + 86-21-64041990 Fax: +86-21-64038472
Received: December 1, 2012
Revised: January 24, 2013
Accepted: February 5, 2013
Published online: March 7, 2013
Processing time: 100 Days and 17.2 Hours
Abstract

AIM: To identify a practical approach for preoperative decision-making in patients with intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.

METHODS: Between March 1999 and November 2006, the clinical characteristics, pathological data and computed tomography/magnetic resonance imaging (CT/MRI) of 54 IPMNs cases were retrieved and analyzed. The relationships between the above data and decision-making for pancreatic resection were analyzed using SPSS 13.0 software. Univariate analysis of risk factors for malignant or invasive IPMNs was performed with regard to the following variables: carcinoembryonic antigen, carbohydrate antigen 19-9 (CA19-9) and the characteristics from CT/MRI images. Receiver operating characteristic (ROC) curve analysis for pancreatic resection was performed using significant factors from the univariate analysis.

RESULTS: CT/MRI images, including main and mixed duct IPMNs, tumor size > 30 mm or a solid component appearance in the lesion, and preoperative serum CA19-9 > 37 U/mL had good predictive value for determining pancreatic resection (P < 0.05), but with limitations. Combining the above factors (CT/MRI images and CA19-9) improved the accuracy and sensitivity for determining pancreatic resection in IPMNs. Using ROC analysis, the area under the curve reached 0.893 (P < 0.01, 95%CI: 0.763-1.023), with a sensitivity, specificity, positive predictive value and negative predictive value of 95.2%, 83.3%, 95.2% and 83.3%, respectively.

CONCLUSION: Combining preoperative CT/MRI images and CA19-9 level may provide useful information for surgical decision-making in IPMNs.

Keywords: Intraductal papillary mucinous neoplasms; Surgical decision-making; Carbohydrate antigen 19-9; Computed tomography/magnetic resonance imaging; Predictor