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

In the last decades, the attention to Intraductal Papillary Mucinous Neoplasms (IPMNs) has risen due to the increase of their incidental diagnosis. The aim of the present study was to evaluate which factors influenced survival in population affected by intraductal papillary mucinous neoplasms. Methods A retrospective study on a prospective database of 357 patients observed at our Institute from January 2007 to December 2016 was conducted. Pre-, intra- and postoperative data were collected. Patients managed conservatively were compared with those who underwent surgery as regards demographic, clinical data, radiological work up, features of the cysts and overall and disease specific survival. Multivariate analyses were carried out in order to assess factors related to patient’s management as well as those related to overall survival. Results Multivariate analysis showed that the factors strongly related to surgery were: site (tail of the pancreas-OR 4.48; P=0.011), presence of mural nodules (OR 15.39; P<0.001), Wirsung duct size >5 mm (OR 8.55; P<0.001), Wirsung duct size ≥ 10 mm (OR 133.75; P<0.001), 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 overall survival 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, jaundice and the presence of mural nodules within the cyst.