Intraductal papillary neoplasms of the bile duct: a European retrospective multicenter observational study (EUR-IPNB study)

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.