Comparative Effectiveness of Resection vs Surveillance for Pancreatic Branch Duct Intraductal Papillary Mucinous Neoplasms With Worrisome Features

摘要: Importance The 2012 international consensus guidelines defined a subcategory of pancreatic branch duct intraductal papillary mucinous neoplasms with “worrisome features,” which may be followed close surveillance. However, given the poor prognosis invasive malignancy, role early, upfront resection requires further investigation. Objective To compare utility vs long-term We hypothesized that surveillance these cystic would offer greater utility. Design, Setting, and Participants A Markov decision analysis model was constructed to estimate 2 management strategies: early Estimates for outcomes, probabilities transitions between disease states, surgical morbidity were derived from literature review articles published 1997 2014. comparative effectiveness model’s variable estimates based on data predominantly by high-volume, tertiary referral centers. Model probability large, retrospective, single-institution reports. For variables, studies using standard-gamble or time-tradeoff methods weight. Main Outcomes Measures Expected measured in terms quality-adjusted life years 3% annual discount. Probabilistic 1-way sensitivity analyses performed assess potential effects uncertainty key variables. Results Early yielded 11.63 life-years during 20 follow-up compared 11.06 indicated has 94% likelihood being more effective than obtained only if each following criteria are met: expectancy is at least 18 years, mortality less 4.3%, baseline preoperative 0.78. Additional drivers outcomes include rate progression worrisome high-risk features finding cancer stigmata. Conclusions Relevance compares favorably features. careful consideration patient factors surgeon imperative.