Original articlePancreas, biliary tract, and liverEffects of Comorbidities on Outcomes of Patients With Intraductal Papillary Mucinous Neoplasms
Section snippets
Methods
The prospective IPMN database at Massachusetts General Hospital, including patients from the Departments of Surgery and Gastroenterology, was analyzed for all patients with IPMNs diagnosed between January 1, 1992 and January 1, 2012. Patients were eligible if they underwent resection with histopathologic confirmation of IPMN or have been followed at Massachusetts General Hospital for presumed IPMN. Patients undergoing just a single consultation without any further follow-up at our institution
Results
A total of 725 patients diagnosed with IPMNs between December 1992 and April 2012 were eligible for study inclusion, whereas 71 patients were ineligible. Three hundred twenty-five patients (45%) were male, and 400 were female; median age at diagnosis was 67 years for both male and female patients. Among the entire cohort 329 patients (45%) were older than 70 years, and 83 (11%) were octogenarians (Table 1). The median duration of follow-up was 5 years (range, 1–19 years), and 121 patients were
Discussion
Longer life expectancy and a rising incidence of IPMN have led to an increase in elderly patients diagnosed with IPMNs. The international guidelines clearly define which patients should be advised to have pancreatic surgery and which observation; however, the recommendations are generally based on morphologic IPMN characteristics and do not include guidance for treatment in elderly and/or multi-morbid patients. Because of this physicians often face the difficult situation to decide whether a
References (22)
- et al.
International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas
Pancreatology
(2012) - et al.
Validation of a combined comorbidity index
J Clin Epidemiol
(1994) - et al.
Use of different comorbidity scores for risk-adjustment in the evaluation of quality of colorectal cancer surgery: does it matter?
Eur J Surg Oncol
(2012) - et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Nonoperative management of main pancreatic duct-involved intraductal papillary mucinous neoplasm might be indicated in select patients
J Am Coll Surg
(2014) - et al.
Outcomes of intraductal papillary mucinous neoplasm with ”Sendai-positive” criteria for resection undergoing non-operative management
Dig Liver Dis
(2013) - et al.
Evolution of the Whipple procedure at the Massachusetts General Hospital
Surgery
(2012) - et al.
Differences between main-duct and branch-duct intraductal papillary mucinous neoplasms of the pancreas
World J Gastrointest Surg
(2010) - et al.
Intraductal papillary mucinous neoplasms of the pancreas
Gastroenterology
(2010) - et al.
Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder
BJU Int
(2012)
Risk for mortality from causes other than pancreatic cancer in patients with intraductal papillary mucinous neoplasm of the pancreas
Pancreas
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2022, Gastroenterology Clinics of North AmericaCitation Excerpt :Several scoring indexes, including the Charlson Comorbidity Index and the Adult Comorbidity Evaluation 27, have been used to help with clinical decisions. High scores on the Charlson Comorbidity Index (>7) are associated with shorter survival and a higher risk of dying from non-IPMN-related causes.103,104 In another study that used the Adult Comorbidity Evaluation 27 scoring system, 793 patients with IPMNs were assessed.
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2021, International Journal of Surgery Case ReportsCitation Excerpt :Follow-up is recommended even for IPMNs with a low risk of malignancy, because malignant transformation may occur over time. The incidence of pancreatic cancer (over a 5-year period) in patients with IPMN is reported to be 2.5%–2.8% [1–7]. Therefore, IPMN is considered a risk factor for pancreatic cancer.
Conflicts of interest The authors disclose no conflicts.