Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
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
Abstract
BACKGROUND

Recurrent acute pancreatitis (RAP) may be a presenting feature of and an indication for resection of pancreatic cysts, including intra-ductal papillary mucinous neoplasm (IPMN). Few data are available regarding the prevalence of malignancy and post-operative RAP in this population.

AIM

To study the role of resection to help prevent RAP and analyze if presentation as RAP would be a predictor for malignancy.

METHODS

This retrospective study assessed 172 patients who underwent surgical resection of pancreatic cystic neoplasms at a university hospital between 2002 and 2016. The prevalence of preoperative high-risk cyst features, and of neoplasia was compared between patients with and without RAP. To identify the cause of pancreatitis, all the patients had a detailed history of alcohol, smoking, medications obtained, and had cross-sectional imaging (contrast-enhanced computed tomography/magnetic resonance imaging) and endoscopic ultrasound to look for gallstone etiology and other structural causes for pancreatitis. The incidence of RAP post-resection was the primary outcome.

RESULTS

IPMN accounted for 101 cases (58.7%) {[branch duct (BD) 59 (34.3%), main duct (MD) 42] (24.4%)}. Twenty-nine (16.9%) presented with RAP (mean 2.2 episodes): 15 had BD-IPMN, 8 MD-IPMN, 5 mucinous cystic neoplasm and 1 serous cystic neoplasm. Malignancy was similar among those with vs without RAP for all patients [6/29 (20.7%) vs 24/143 (16.8%)] and IPMN patients [6/23 (26.1%) vs 23/78 (29.5%)], although tended to be higher with RAP in BD-IPMN, [5/15 (33.3%) vs 3/44 (6.8%), P = 0.04]. At mean follow-up of 7.2 years, 1 (3.4%) RAP patient had post-resection RAP. The mean episodes of acute pancreatitis before vs after surgery were 3.4 vs 0.02 (P < 0.0001).

CONCLUSION

Malignancy was not increased in patients with pancreatic cystic neoplasms who have RAP compared to those without RAP. In addition, specific cyst charac-teristics were not clearly associated with RAP. The incidence of RAP was markedly decreased in almost all patients following cyst resection.

Keywords: Pancreatic cyst, Pancreatic neoplasm, Pancreatitis, Malignancies

Core Tip: Our findings from this original study support international consensus guidelines recommendations for surgical resection of pancreatic cystic neoplasms presenting with acute pancreatitis but more for the effective treatment of recurrent acute pancreatitis (RAP) rather than for the identification of malignancy. 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.