Surgical Intervention and Prognosis of Intraductal Papillary Mucinous Adenoma in Elderly Patients: A Single Center Retrospective Study

IF 2.5 Q3 GERIATRICS & GERONTOLOGY

Aging Medicine Pub Date : 2025-05-13 DOI:10.1002/agm2.70022

Tianhan Sun, Meilan Liu, Qing Wang, Boyue Jiang, Tong Li, Jianfu Cao, Jinghai Song, Jingyong Xu, Hongyuan Cui

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Abstract

Objective

The incidence of intraductal papillary mucinous neoplasm (IPMN) is rising among elderly patients. This study aims to investigate the clinical features of IPMN in elderly patients (≥ 60 years), analyze risk factors for high-grade dysplasia (HGD) and invasive cancer (IC), and provide treatment recommendations for elderly patients with IPMN.

Methods

In this single-center retrospective case–control study, 58 consecutive elderly patients (≥ 60 years) who underwent IPMN surgery at Beijing Hospital between January 2014 and November 2023 were included. Clinical characteristics across IPMN subtypes were compared, risk factors were analyzed, and the predictive values of the 2017 Fukuoka and 2023 Kyoto guidelines were evaluated. Follow-up and survival outcomes were also examined.

Results

The proportion of patients with main-duct IPMN (MD-IPMN) and mixed-type IPMN (MT-IPMN) who had diabetes was significantly higher than among those with branch-duct IPMN (BD-IPMN) (p < 0.05). The average postoperative hospital stay for patients with low-grade dysplasia (LGD) was 17.7 days (range, 6–53 days), while for patients with HGD/IC, it was 25.5 days (range, 9–90 days), with a statistically significant difference (p < 0.05). Jaundice, elevated CA19-9, elevated CEA, main duct (MD) > 10 mm, and IPMN subtype were significant predictors of HGD/IC (p < 0.05), with elevated CA19-9 and IPMN subtype identified as independent risk factors (p < 0.05). The 2023 Kyoto guidelines showed higher sensitivity but lower specificity than the 2017 Fukuoka guidelines for detecting HGD/IC (p < 0.05 for both). There was a statistically significant difference in overall survival between patients with LGD and those with HGD/IC following surgery (p < 0.05), while no significant difference in postoperative survival was observed between HGD/IC patients with and without lymph node metastasis (p > 0.05).

Conclusions

Surgical resection is recommended for elderly patients with MD-IPMN or MT-IPMN combined with elevated CA19-9. The 2017 Fukuoka guidelines are preferable to the 2023 Kyoto guidelines for managing elderly IPMN patients.

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老年患者导管内乳头状粘液腺瘤的手术干预与预后：单中心回顾性研究

目的导管内乳头状粘液瘤（IPMN）在老年患者中的发病率呈上升趋势。本研究旨在探讨老年（≥60岁）IPMN患者的临床特征，分析高级别发育不良（HGD）和侵袭性癌（IC）的危险因素，为老年IPMN患者提供治疗建议。方法本研究为单中心回顾性病例对照研究，纳入2014年1月至2023年11月在北京医院连续行IPMN手术的58例老年患者（≥60岁）。比较IPMN各亚型的临床特征，分析危险因素，并评估2017年福冈指南和2023年京都指南的预测价值。随访和生存结果也被检查。结果主管IPMN （MD-IPMN）和混合型IPMN （MT-IPMN）合并糖尿病的患者比例显著高于支管IPMN （BD-IPMN）患者（p < 0.05）。低级别发育不良（LGD）患者术后平均住院时间为17.7天（范围6 ~ 53天），高级别发育不良/IC患者术后平均住院时间为25.5天（范围9 ~ 90天），差异有统计学意义（p < 0.05）。黄疸、CA19-9升高、CEA升高、主导管(MD)≥10 mm、IPMN亚型是HGD/IC的显著预测因子（p < 0.05），其中CA19-9升高和IPMN亚型为独立危险因素（p < 0.05）。2023年《京都指南》在检测HGD/IC方面的敏感性高于2017年《福冈指南》（p < 0.05），但特异性较低。LGD患者术后总生存率与HGD/IC患者术后总生存率差异有统计学意义（p < 0.05）， HGD/IC患者术后生存率与无淋巴结转移患者无统计学差异（p > 0.05）。结论老年MD-IPMN或MT-IPMN合并CA19-9升高的患者建议手术切除。2017年福冈指南比2023年京都指南更适用于老年IPMN患者的管理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Aging Medicine Medicine-Geriatrics and Gerontology

CiteScore

4.10

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0.00%

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