24 | wetenschapsdag 2023 Sessie 1a: Viatris: Pantastische Pancreas-Perikelen x3 Auteurs C.A. Leseman, T.Y.S.. le Large, L. Brouwer-Hol, M.W.J. Stommel, B.A. Bonsing, C. van Eijck, R.P. Voermans, S. Lekkerkerker, B. Groot Koerkamp, H.C. van Santvoort, O.R. Busch, I.Q. Molenaar, G. Kazemier, M.G. Besselink Abstract titel Nationwide use and outcome of pancreatectomy for IPMN: should guidelines take the type of pancreatic resection required into account Background Current guidelines on intraductal papillary mucinous neoplasm (IPMN) do not take the location of IPMN (e.g. pancreatic head, body, tail) and the associated required pancreatic resection into account when advising pancreatic resection. This could be relevant as outcomes may differ although large multicenter studies on the outcome of pancreatoduodenectomy, left-sided pancreatectomy, and total pancreatectomy for IPMN are lacking. Therefore, this nationwide study aimed to evaluate the outcomes associated with pancreatectomy for IPMN. Methods Nationwide, retrospective analysis of all consecutive patients after pancreatectomy for pathology proven IPMN from the mandatory prospective Dutch Pancreatic Cancer Audit (2014-2020). Primary outcomes were in-hospital/30-day mortality and major morbidity (Clavien-Dindo grade 3). Only complications defined as ISGPS grade B/C were included. Trends in use and outcomes per pancreatectomy were evaluated. Results Overall, 396 patients underwent pancreatectomy for IPMN, including pancreato-duodenectomy (PD; n = 246, 62%), left-sided pancreatectomy (LP; n = 130, 33%), and total pancreatectomy (TP; n = 20, 5%). The rate of in-hospital/30-day mortality was 2.0% and did not differ significantly between groups (2.8%, 0%, 5.0%, p = 0.257). The rate of major morbidity was 32% and did not differ significantly (36%, 25%, 25% p = 0.545). The rates of postoperative pancreatic fistula (POPF; 17%, 15%, NR, p = 0.140) and bile leak (12%, NR, 5%, p = 0.694) did not differ significantly between groups, whereas delayed gastric emptying was reported more often after PD (DGE; 23%, 2%, 20%, p = 0.0001). Mean length of hospital stay was 14.7 days (SD 14.6) and shortest after LP (17.8, 8.8, 15.1 days, p<0.001). The 30-day readmission rate was the highest after PD (27%, 18%, 0%, p = 0.003). Final pathology showed high grade dysplasia (HGD) in 69 patients (17%), mostly after TP (20%, 10%, 40%, p <0.001). The use of pancreatectomy for IPMN remained stable, whereas the use of TP decreased (Pearson r 0.281; -0.579, respectively).
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