Muniraj T, Aslanian HR, Laine L, Jamidar PA, Farrell JF, Mitchell KA, Salem RR. Resection of pancreatic cystic neoplasms in recurrent acute pancreatitis prevents recurrent pancreatitis but does not identify more malignancies. World J Gastroenterol 2021; 27(15): 1630-1642 [PMID: 33958848 DOI: 10.3748/wjg.v27.i15.1630]
Corresponding Author of This Article
Thiruvengadam Muniraj, MD, Assistant Professor, Department of Digestive Diseases, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, United States. thiruvengadam.muniraj@yale.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Apr 21, 2021; 27(15): 1630-1642 Published online Apr 21, 2021. doi: 10.3748/wjg.v27.i15.1630
Resection of pancreatic cystic neoplasms in recurrent acute pancreatitis prevents recurrent pancreatitis but does not identify more malignancies
Thiruvengadam Muniraj, Harry R Aslanian, Loren Laine, Priya A Jamidar, James F Farrell, Kisha A Mitchell, Ronald R Salem
Thiruvengadam Muniraj, Harry R Aslanian, Loren Laine, Priya A Jamidar, James F Farrell, Section of Digestive Diseases, Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
Kisha A Mitchell, Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, United States
Ronald R Salem, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, United States
Author contributions: Muniraj T, Aslanian HR, Laine L and Salem RR performed the study design; Muniraj T, Aslanian HR, and Salem RR performed the data acquisition; Muniraj T performed the statistical analysis; Muniraj T, Aslanian HR, and Laine L drafting of the manuscript; all authors performed data interpretation, review of manuscript for important intellectual content, final approval of the manuscript, and access to the data and a role in writing the manuscript.
Institutional review board statement: The study was reviewed and approved by the Yale University Institutional Review Board, USA, No. 2000029508.
Informed consent statement: The signed informed consent forms have been waived by the Yale University Institutional Review Board.
Conflict-of-interest statement: They authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thiruvengadam Muniraj, MD, Assistant Professor, Department of Digestive Diseases, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, United States. thiruvengadam.muniraj@yale.edu
Received: December 21, 2020 Peer-review started: December 21, 2020 First decision: January 10, 2021 Revised: January 24, 2021 Accepted: March 22, 2021 Article in press: March 22, 2021 Published online: April 21, 2021 Processing time: 113 Days and 21.3 Hours
ARTICLE HIGHLIGHTS
Research background
Pancreatic cystic neoplasms may present recurrent acute pancreatitis (RAP). Little is known on the role of resection for preventing RAP and if any correlation of higher prevalence of malignancy is seen among these patients.
Research motivation
Predicting malignancy among the pancreatic cystic neoplasms and management of RAP is challenging.
Research objectives
The objective of this research was to study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for malignancy.
Research methods
We adopted a retrospective cohort study model, enrolling all the patients with pancreatic cystic neoplasms who underwent surgical resection and compare between those who presented with RAP and without RAP. Incidence of RAP after resection and prevalence of malignancy among those who presented with RAP were the primary outcomes.
Research results
Malignancy was similar among those with vs without RAP for all patients 20.7% vs 16.8%. The mean episodes of acute pancreatitis before vs after surgery were 3.4 vs 0.02 (P < 0.0001). These findings clearly contribute much to this area of science. Although, this study clearly shows the risk reduction of RAP after the pancreatic resection, further investigation with large population prospective study is needed to prove a causal relationship between the cause of RAP and pancreatic resection.
Research conclusions
When patients with RAP are noted to have pancreatic cysts, it should be emphasized to differentiate if those cysts are the cause or the effect of RAP, i.e., if cystic neoplasms are causing the RAP or if cysts are pseudocysts as a result of RAP. Larger data is needed to see if there exists a causal relationship. Similar to the presentation of jaundice as a predictor for malignancy among pancreas cystic neoplasms, RAP may have a role as a predictor of high-risk cysts.
Research perspectives
Future research to be focused on a larger prospective cohort to answer the above two questions.
