Diagnostic performance of current guidelines and postoperative outcome following surgical treatment of cystic pancreatic lesions – a 10-year single center experience

Abstract

Objective

Pancreatic cystic lesions (PCLs) are diagnostically challenging and there are currently several different guidelines. The aim of this study was to compare diagnostic performance of the most widely utilized International Association of Pancreatology (IAP) guidelines and the recent evidence-based European guidelines and to report on postoperative outcomes following surgical treatment of PCLs.

Methods

This is a retrospective single-center study of patients undergoing surgery due to a PCL between 2010 and 2019. Primary outcome was a comparison of diagnostic performance between IAP and European guidelines, measured in area under the receiver operating characteristic curve (AUC). Other outcomes included diagnostic performance of different risk features, 30-day postoperative mortality and major morbidity, final diagnosis, and overall survival.

Results

We identified 137 patients, three of whom did not undergo curative surgery due to metastatic disease. Overall, there was no difference in the performance of the two guidelines with AUC values ranging from 0.572–0.610 and 0.607–0.621 for IAP and European guidelines respectively. Postoperative 30-day mortality and major morbidity were 0% (95% CI 0.0–2.7%) and 37.3% (95% CI 29.1–46.1%), respectively. More than half of the resected lesions (52.6%) were low-grade dysplastic or non-neoplastic.

Conclusions

Overall, the IAP and the European guidelines performed equally, although European guidelines had a slightly higher mean specificity. Pancreatic surgery is associated with high major morbidity, and there is a need for new diagnostic tools and strategies in order to decrease the amount of overtreatment in patients with PCL.

Keywords:

• IPMN
• pancreas-clinical
• pancreatic cyst
• guidelines
• Fukuoka

Acknowledgements

The authors wish to thank Danish Cancer Society, Arvid Nilsson Foundation, Ingrid Munkholm Foundation, Toyota Foundation, Novo Nordisk Foundation, Harboefonden, Tømrermester Jørgen Holm og hustru Elisa f. Hansens Mindelegat, and Herlev Hospital Research Foundation for their financial support.

Author contributions

B.K., P.K., C.P.H., P.V. and J.G.K. conceived and planned the study. B.K. developed the theoretical formalism and drafted the study protocol. All authors approved the protocol. B.K. and M.C.H. collected the data. T.S.K. developed a standardized scheme and reviewed cross-sectional imaging. B.K. analyzed the data and drafted the manuscript. All authors had access to study data and actively participated in manuscript editing. The final version of the manuscript has been read and approved by all authors.

Disclosure statement

No potential conflict of interest was reported by the author(s). The requirements for authorship have been met, and each author believes that the manuscript represents honest work. This manuscript has not been submitted nor is being considered for publication elsewhere.

Additional information

Funding

This work was supported by the Danish Cancer Society, Arvid Nilsson Foundation, Ingrid Munkholm Foundation, Toyota Foundation, Novo Nordisk Foundation, Harboefonden, Tømrermester Jørgen Holm og hustru Elisa f. Hansens Mindelegat, Herlev Hospital Research Foundation and Kraeftens Bekaempelse.