[en] [en] BACKGROUND/PURPOSE: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers.
METHODS: A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between January 1, 2010, and December 31, 2020 was gathered under the auspices of the E-AHPBA. Textbook outcome was defined as non-prolonged length of hospital stay plus absence of any Clavien-Dindo grade ≥III complication, readmission, or mortality within 90 postoperative days.
RESULTS: A total of 28 centers contributed 85 patients who underwent surgery for IPNB. Median age was 66 years (55-72), 49.4% were women and 87.1% Caucasian. Open surgery was performed in 72 patients (84.7%), laparoscopic in 13 (15.3%). Textbook outcome was achieved in 54.1% of patients, reaching 63.8% after liver resection, and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI 50-82). Overall survival was better in patients with Charlson comorbidity score ≤4 versus >4 (P=0.016), intra- versus extra-hepatic tumor (P=0.027), single versus multiple tumor (P=0.007), those who underwent hepatic versus pancreatic resection (P=0.017), or achieved versus failed textbook outcome (P=0.029). Multivariable Cox regression analysis showed that not achieving textbook outcome (HR 4.20, 95% CI 1.11-15.94, P=0.03) was an independent prognostic factor of poor overall survival.
CONCLUSIONS: Patients undergoing liver resection for IPNB were more likely to achieve a textbook outcome than those requiring a pancreatic resection. Comorbidity, tumor location and tumor multiplicity influenced overall survival. Textbook outcome was an independent prognostic factor of overall survival.
Disciplines :
Surgery Oncology
Author, co-author :
Lluís, Núria ; Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
Serradilla-Martín, Mario ; Instituto de Investigación Sanitaria Aragón, Department of Surgery, Miguel Servet University Hospital, Zaragoza, Spain
Achalandabaso, Mar ; HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Jehaes, François; HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
Dasari, Bobby V M; Liver Transplant and HPB Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
Mambrilla-Herrero, Sara ; Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
Sparrelid, Ernesto; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Balakrishnan, Anita ; Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
Hoogwater, Frederik J H ; HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Amaral, Maria João ; General Surgery, Centro Hospitalar e Universitário de Coimbra, and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
Andersson, Bodil; Department of Surgery, Lund University and Skane University Hospital, Lund, Sweden
Berrevoet, Frederik ; General and HPB Surgery, and Liver Transplantation, University Hospital Gent, Gent, Belgium
Doussot, Alexandre ; Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besançon, France
López-López, Víctor ; General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
Alsammani, Mohammedsuror ; WITS University, Johannesburg, South Africa
Detry, Olivier ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation
Domingo-Del Pozo, Carlos ; General and Digestive Surgery, Hospital Doctor Peset, Valencia, Spain
Machairas, Nikolaos ; Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
Pekli, Damján; Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
Alcázar-López, Cándido F ; HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
Asbun, Horacio ; Division of Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, Miami, FL, USA
Björnsson, Bergthor ; Department of Surgery in Linköping and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Christophides, Thalis; General Surgery Department, HPB Division, Nicosia General Hospital, Nicosia, Cyprus
Díez-Caballero, Alberto ; Quirúrgica Cirujanos Asociados, Centro Médico Teknon, Barcelona, Spain
Francart, David; Department of Abdominal Surgery, CHC Groupe Santé, Liège, Belgium
Noel, Colin B; HPB Clinical Unit, Gastrointestinal Surgery, Universitas Academic Hospital, University of the Free State, South Africa
Sousa-Silva, Donzília ; HEBIPA Surgery, Centro Hospitalar Universitário do Porto, Portugal
Toledo-Martínez, Enrique ; Hospital Universitario Marqués de Valdecilla, Santander, Spain
Tzimas, George N ; HPB Surgery, Department of Surgery, Hygeia Hospital, Athens, Greece
Yaqub, Sheraz ; HPB Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
Cauchy, François; HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
Prieto-Calvo, Mikel ; Hepatobiliary Surgery and Liver Transplant Unit, Cruces University Hospital, Bilbao, Spain
D'Souza, Melroy A ; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Spiers, Harry V M ; Cambridge HPB Unit, Cambridge University Hospitals NHS Foundation Trust, and Department of Surgery, University of Cambridge, Cambridge, UK
van den Heuvel, Marius C ; HPB Surgery and Liver Transplantation, and Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Charco, Ramón; HPB Surgery and Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain
Lesurtel, Mickaël ; HPB Surgery & Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris, University of Paris Cité, Clichy, France
Ramia, José Manuel; HPB Surgery and Liver Transplantation, Dr. Balmis General University Hospital, and Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain ; Miguel Hernández University, Alicante, Spain
