Resection of pancreatic cystic neoplasms in recurrent acute pancreatitis prevents recurrent pancreatitis but does not identify more malignancies

doi:10.3748/wjg.v27.i15.1630

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World Journal of Gastroenterology

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Gastroenterol. Apr 21, 2021; 27(15): 1630-1642
Published online Apr 21, 2021. doi: 10.3748/wjg.v27.i15.1630

Table 1 Types of pancreatic cysts

IPMN cysts (total)	101
BD-IPMN	59
MD-IPMN	42
Non-IPMN cysts (total)	71
Mucinous cystic neoplasm	32
Serous cystic neoplasm	16
Pancreatic neuroendocrine tumor	11
Solid pseudopapillary epithelial neoplasm	6
Squamoid	3
Benign	2
Cystic degeneration	1

IPMN: Intra-ductal papillary mucinous neoplasm; MD-IPMN: Main duct-IPMN; BD-IPMN: Branch duct-IPMN.

Table 2 Incidence of recurrent acute pancreatitis episodes in recurrent acute pancreatitis patients

	Episodes per patient-year (mean + SD)		Mean difference [95%CI]	P value
	Pre-resection	Post-resection	Mean difference [95%CI]	P value
All cysts (n = 29)	3.40 (4.46)	0.02 (0.08)	3.38 [1.76, 5.00]	< 0.0001
IPMN (n = 23)	2.32 (1.69)	0.03 (0.09)	2.29 [1.60, 2.98]	< 0.0001
BD-IPMN (n = 15)	2.06 (1.85)	0.04 (0.11)	2.02 [1.08, 2.96]	< 0.0001
MD-IPMN (n = 8)	2.81 (1.32)	0 (0)¹	2.81 [1.83, 3.79]	< 0.0001
Non-IPMN (n = 6)	7.52 (8.53)	0 (0)¹	7.52 [0.69, 14.35]	0.03

¹In order to calculate mean differences and risk ratios, a standard deviation of 0.0001 was substituted for zero. IPMN: Intra-ductal papillary mucinous neoplasm; MD-IPMN: Main duct-IPMN; BD-IPMN: Branch duct-IPMN; SD: Standard deviation; CI: Confidence interval.

Table 3 Characteristics of all patients (n = 172)

	With RAP (n = 29)	Without RAP (n = 143)	Risk difference [95%CI]	P value
	n (%)	n (%)	Risk difference [95%CI]	P value
Median age	61 (IQR 18)	65 (IQR 15)	NA	0.65
Sex (M)	13 (44.8)	58 (40.6)	NA	0.67
Location of cyst
Head	16 (55.2)	65 (45.5)	0.10 [-0.10, 0.30]	0.34
Neck	2 (6.9)	7 (4.9)	0.02 [-0.08, 0.12]	0.69
Body	8 (27.6)	32 (22.4)	0.05 [-0.12, 0.23]	0.56
Tail	3 (10.3)	37 (25.9)	-0.16 [-0.29, -0.02]	0.02
Diffuse	0 (0)	2 (1.4)	-0.01 [-0.06, 0.04]	0.59
Main pancreas duct > 10	4 (13.8)	10 (7.0)	0.07 [-0.06, 0.20]	0.31
Cyst size > 3	6 (20.7)	36 (25.2)	-0.04 [-0.21, 0.12]	0.59
Solid component	7 (24.1)	46 (32.2)	-0.08 [-0.25, 0.09]	0.36
Malignancy	6 (20.7)	24 (16.8)	0.04 [-0.12, 0.20]	0.63
Pathological subtype
Intestinal	10 (34.5)	11 (7.7)	0.27 [0.09, 0.45]	0.003
Gastric	3 (10.3)	43 (30.1)	-0.20 [-0.33, -0.06]	0.004
Pancreatobiliary	7 (24.1)	15 (10.5)	0.14 [-0.03, 0.30]	0.10
Oncocytic	0 (0)	3 (2.1)	-0.02 [-0.07, 0.03]	0.43
Unknown	9 (31.0)	71 (49.7)	-0.19 [-0.37, 0.001]	0.05
Cyst type
IPMN total	23 (79.3)	78 (54.5)	0.25 [0.08, 0.41]	0.004
BD-IPMN	15 (51.7)	44 (30.8)	0.21 [0.01, 0.41]	0.04
MD-IPMN	8 (27.6)	34 (23.8)	0.04 [-0.14, 0.22]	0.67
Non-IPMN	6 (20.7)	65 (45.5)	-0.25 [-0.42, -0.08]	0.004

RAP: Recurrent acute pancreatitis; IPMN: Intra-ductal papillary mucinous neoplasm; MD-IPMN: Main duct-IPMN; BD-IPMN: Branch duct-IPMN; IQR: Interquartile range; CI: Confidence interval.

Table 4 Characteristics of patients with intra-ductal papillary mucinous neoplasm with and without recurrent acute pancreatitis

	With RAP (n = 23)	Without RAP (n = 78)	Risk difference [95%CI]	P value
	n (%)	n (%)	Risk difference [95%CI]	P value
Median age	64 (IQR 17)	67 (IQR 12)	NA	0.64
Sex (M)	13 (56.5)	38 (48.7)	NA	0.51
Location of cyst
Head	16 (69.6)	46 (59)	0.11 [-0.11, 0.32]	0.34
Body/Tail	7 (30.4)	32 (41)	-0.11 [-0.32, 0.11]	0.34
Main pancreas duct > 10	4 (17.4)	10 (12.8)	0.05 [-0.13, 0.22]	0.60
Cyst size > 3 cm	6 (26)	36 (46.2)	-0.20 [-0.41, 0.01]	0.06
Solid component	5 (21.7)	20 (25.6)	-0.04 [-0.23, 0.16]	0.69
Malignancy	6 (26.1)	23 (29.5)	-0.03 [-0.24, 0.17]	0.75
Pathological subtype
Intestinal	8 (34.8)	10 (12.8)	0.22 [0.01, 0.43]	0.04
Gastric	3 (13)	42 (53.9)	-0.41 [-0.58, -0.23]	< 0.0001
Pancreatobiliary	7 (30.4)	15 (19.2)	0.11 [-0.10, 0.32]	0.29
Oncocytic	0 (0%)	3 (3.8)	-0.04 [-0.11, 0.03]	0.30
Unknown	5 (21.8)	8 (10.3)	0.11 [-0.07, 0.30]	0.22

RAP: Recurrent acute pancreatitis; IQR: Interquartile range; CI: Confidence interval.

Table 5 Characteristics of patients with branch-duct intra-ductal papillary mucinous neoplasm with and without recurrent acute pancreatitis

	With RAP (n = 15)	Without RAP (n = 44)	Risk difference [95%CI]	P value
	n (%)	n (%)	Risk difference [95%CI]	P value
Median age	60 (IQR 23)	65 (IQR 12.5)	NA	0.50
Sex (M)	8 (53.3)	24 (54.6)	NA	0.94
Location of cyst
Head	11 (73)	28 (64)	0.10 [-0.17, 0.36]	0.47
Body/Tail	4 (9.1)	16 (36)	-0.10 [-0.36, 0.17]	0.47
Main pancreas duct > 10	2 (13.3)	2 (4.6)	0.09 [-0.10, 0.27]	0.35
Cyst size > 3 cm	6 (40)	21 (47.7)	-0.08 [-0.37, 0.21]	0.60
Solid component	2 (13.3)	4 (9.1)	0.04 [-0.15, 0.23]	0.66
Malignancy	5 (33.3)	3 (6.8)	0.27 [0.02, 0.52]	0.04
Pathological subtype
Intestinal	7 (46.7)	4 (9.1)	0.38 [0.11, 0.64]	0.006
Gastric	0	30 (68.2)	-0.68 [-0.84, -0.52]	< 0.001
Pancreatobiliary	4 (26.7)	7 (16)	0.11 [-0.14, 0.36]	0.4
Oncocytic	0	0	NA	NA
Unknown	4 (26.7)	3 (6.8)	0.20 [-0.04, 0.43]	0.10

RAP: Recurrent acute pancreatitis; IQR: Interquartile range; NA: Not available; CI: Confidence interval.

Table 6 Multivariable analysis of all patients (n = 172)

	With RAP (n = 29)	Without RAP (n = 143)	P value
	Odds ratio	95%CI	P value
Location of cyst
Head	-
Neck	1.240013	[0.19933, 7.713993]	0.818
Body	1.736854	[0.570778, 5.285173]	0.331
Tail	0.686678	[0.155679, 3.028833]	0.62
Diffuse	-
Pathological subtype
Intestinal
Gastric	0.059886	[0.013402, 0.267608]	< 0.001
Pancreatobiliary	0.454606	[0.122387, 1.688636]	0.239
Oncocytic	-
Unknown	0.355592	[0.088518, 1.428472]	0.145
Cyst type
IPMN total	3.462462	[0.782586, 15.31927]	0.102
BD-IPMN	1.660612	[0.558816, 4.934779]	0.361
MD-IPMN	-

RAP: Recurrent acute pancreatitis; IPMN: Intra-ductal papillary mucinous neoplasm; MD-IPMN: Main duct-IPMN; BD-IPMN: Branch duct-IPMN; CI: Confidence interval.

Table 7 Multivariable analysis of patients with intra-ductal papillary mucinous neoplasm with and without recurrent acute pancreatitis

	With RAP (n = 29)	Without RAP (n = 143)	P value
	Odds ratio	95%CI	P value
Location of cyst
Head	-	-
Neck	1.265446	[0.169046, 9.472912]	0.819
Body	0.506621	[0.111835, 2.295024]	0.378
Tail	0.572817	[0.090659, 3.619267]	0.554
Diffuse	-	-
Pathological subtype
Intestinal	-	-
Gastric	0.096091	[0.020977, 0.440165]	0.003
Pancreatobiliary	0.773074	[0.199147, 3.001027]	0.71
Oncocytic	-
Unknown	1.034683	[0.214488, 4.991279]	0.966
Cyst type
IPMN total
BD-IPMN	1.571892	[0.530571, 4.65695]	0.414
MD-IPMN	-

RAP: Recurrent acute pancreatitis; IPMN: Intra-ductal papillary mucinous neoplasm; MD-IPMN: Main duct-IPMN; BD-IPMN: Branch duct-IPMN; CI: Confidence interval.

Table 8 Multivariable analysis patients with branch-duct intra-ductal papillary mucinous neoplasm with and without recurrent acute pancreatitis

	With RAP (n = 29)	Without RAP (n = 143)	P value
	Odds ratio	95%CI	P value
Location of cyst
Head	-	-
Neck	-	-
Body	0.61173	[0.059835, 6.254136]	0.679
Tail	0.537057	[0.050552, 5.705601]	0.606
Diffuse	-	-
Pathological subtype
Intestinal	-	-
Gastric	-	-
Pancreatobiliary	0.461648	[0.063565, 3.352753]	0.445
Oncocytic	-	-
Unknown	1.458186	[0.15039, 14.13861]	0.745

RAP: Recurrent acute pancreatitis; CI: Confidence interval.

Citation: 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
URL: https://www.wjgnet.com/1007-9327/full/v27/i15/1630.htm
DOI: https://dx.doi.org/10.3748/wjg.v27.i15.1630