Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)
Núria Lluís, Mario Serradilla‐Martín, Mar Achalandabaso Boira, François Jehaes, B. Dasari, S. Mambrilla-Herrero, Ernesto Sparrelid, Anita Balakrishnan, Frederik J.H. Hoogwater, Maria João Amaral, Bodil Andersson, Frederik Berrevoet, Alexandre Doussot, Víctor López‐López, Mohammedsuror Alsammani, Olivier Detry, Carlos Domingo del Pozo, Nikolaos Machairas, Damján Pekli, C. Alcázar, Horacio J. Asbun, Bergþór Björnsson, Thalis Christophides, A Díez-Caballero, D. Francart, Colin Noel, Donzília Sousa Silva, Enrique Toledo, George N. Tzimas, Sheraz Yaqub, François Cauchy, Mikel Prieto, Melroy A. D’Souza, Harry Spiers, Marius C. van den Heuvel, R. Charco, Mickaël Lesurtel, José M. Ramia
Abstract
BACKGROUND/PURPOSE: Intraductal papillary neoplasm of the bile duct (IPNB) is a rare disease in Western countries. The main aim of this study was to characterize current surgical strategies and outcomes in the mainly European participating centers. METHODS: A multi-institutional retrospective series of patients with a diagnosis of IPNB undergoing surgery between 1 January 2010 and 31 December 2020 was gathered under the auspices of the European-African Hepato-Pancreato-Biliary Association. The textbook outcome (TO) was defined as a non-prolonged length of hospital stay plus the absence of any Clavien-Dindo grade at least III complications, readmission, or mortality within 90 postoperative days. RESULTS: A total of 28 centers contributed 85 patients who underwent surgery for IPNB. The median age was 66 years (55-72), 49.4% were women, and 87.1% were Caucasian. Open surgery was performed in 72 patients (84.7%) and laparoscopic in 13 (15.3%). TO was achieved in 54.1% of patients, reaching 63.8% after liver resection and 32.0% after pancreas resection. Median overall survival was 5.72 years, with 5-year overall survival of 63% (95% CI: 50-82). Overall survival was better in patients with Charlson comorbidity score 4 or less versus more than 4 ( P =0.016), intrahepatic versus extrahepatic tumor ( P =0.027), single versus multiple tumors ( P =0.007), those who underwent hepatic versus pancreatic resection ( P =0.017), or achieved versus failed TO ( P =0.029). Multivariable Cox regression analysis showed that not achieving TO (HR: 4.20; 95% CI: 1.11-15.94; P =0.03) was an independent prognostic factor of poor overall survival. CONCLUSIONS: Patients undergoing liver resection for IPNB were more likely to achieve a TO outcome than those requiring a pancreatic resection. Comorbidity, tumor location, and tumor multiplicity influenced overall survival. TO was an independent prognostic factor of overall survival.