Intraductal papillary mucinous neoplasms: the bologna experience. Lessons learned from 357 cases observed in a tertiary care center

Context. In the last decades, the attention to Intraductal Papillary Mucinous Neoplasms (IPMNs) has raised due to the increase of their incidental diagnosis. Objective. The aim of our study was to evaluate which factors influenced survival in our population affected by IPMN. Methods. A retrospective study on a prospective da- tabase of 357 patients observed at our institution from January 2004 until January 2016 was conducted. Pre-, intra- and postoperative data were collected. Patients managed conservatively were compared with those who underwent surgery as regards demographic, clini- cal data, radiological work up, features of the cysts and overall survival (OS). Multivariate analyses were carried out in order to assess factors related to patients’ man- agement as well as those related to OS. Results. Multivariate analysis showed that the factors strongly related to surgery were: location in the tail of the pancreas (OR 4.48; P=0.011), presence of mu- ral nodules (OR 15.39; P<0.001), Wirsung size > 5 mm (OR 8.55; P<0.001), Wirsung size ≥ 10mm (OR 133.75; P<0.001), a positive citology (OR 19.81; P=0.008) and acute pancreatitis (OR 16.7; P<0.001); conversely, age was independently related to the follow-up strategy (OR 0.93; P=0.001). Furthermore, parameters that significantly influenced OS were: age (HR 1.07; P<0.001), jaundice (HR 7.67; P<0.001) and the presence of mural nodules (HR 2.03; P=0.019). Conclusions. Despite the limitations of the study, the main factors related to OS in our experience were age- ing, jaundice and the presence of mural nodules within the cyst.