Factores asociados al riesgo de malignidad en la neoplasia intraductal papilar mucinosa de páncreas

Javier Targarona; Sebastián Legua-Pérez; Guillermo Coayla; Gilbert Roman; Eduardo Morales; Alexia Venturo; Luis Rivero; Diego Rivas; Roberto Carrasco

doi:10.47892/rgp.2025.452.1860

Authors

Javier Targarona Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú. https://orcid.org/0000-0002-6055-1248
Sebastián Legua-Pérez Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú; Departamento de Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0002-9032-6586
Guillermo Coayla Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú; Departamento de Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0009-0006-2985-4861
Gilbert Roman Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú; Departamento de Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0009-0003-3976-6783
Eduardo Morales Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú; Departamento de Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0002-6945-6490
Alexia Venturo Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú. https://orcid.org/0009-0008-4795-1133
Luis Rivero Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú; Departamento de Cirugía General y Digestiva, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0009-0009-9625-9749
Diego Rivas Departamento de Cirugía General y Digestiva, Clínica Delgado, Lima, Perú. https://orcid.org/0000-0001-7686-3951
Roberto Carrasco Universidad Continental, Huancayo, Perú. https://orcid.org/0000-0002-8730-3295

DOI:

https://doi.org/10.47892/rgp.2025.452.1860

Keywords:

Pancreatic Intraductal Neoplasms, Pancreatic Neoplasms, Pancreatic Diseases, Pancreatic Diseases, Carcinoma, Pancreatic Ductal

Abstract

Objective: The objective of this study is to analyze the main clinical and epidemiological factors related to the risk of malignancy in intraductal papillary mucinous neoplasia of the pancreas in a cohort of patients seen at a referral clinic in Lima, Peru, based on the criteria of the IAP/Fukuoka guidelines. Materials and methods: This is a retrospective cohort study, which evaluated patients diagnosed with pancreatic IPMN from December 2015 to August 2023. They were classified according to involvement of the main branch, side branch, and mixed pancreatic ducts, considering aspects such as high-risk stigmata, concerning factors, age, sex, medical history, and others. Results: A total of 253 patients with pancreatic IPMN were included, 71.2% had side branch IPMNs, 9% had main branch IPMNs, and 19.8% were mixed. 49 patients (19.4%) underwent surgery at the time of diagnosis due to high-risk stigmata or factors concerning for malignancy. The remaining 204 patients were enrolled in a follow-up program for a mean of 31 months (6–100 months). During follow-up, a decision was made to operate on 38 of them. Of the 87 patients operated on, 36.7% presented invasive cancer and 11.4% high-grade dysplasia. The presence of a mural nodule greater than 5 mm increased the probability of malignancy 11.21 times; jaundice increased the risk of malignancy by more than 5 times. Wirsung duct dilation between 5 and 9.9 mm had a prevalence ratio (PR) of 2.12, and for dilation greater than 10 mm, a PR of 4.69 (p<0.05). The presence of three or more risk factors showed a PR of 6.77 in the bivariate analysis, and an adjusted prevalence ratio (aPR) of 17.11 in the multivariate analysis. Conclusion: Diagnosis and periodic monitoring of IPMNs allow for early detection of potentially malignant lesions, allowing for timely, often curative, surgery. However, there is currently no reliable way to diagnose and identify which cystic lesions already present or are likely to present malignant characteristics, thus providing clear indications for surgical intervention in these patients.

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