Características Clínicas, Imagiológicas e Patológicas das Neoplasias Mucinosas Papilares Intraductais Submetidas a Resseção Cirúrgica

Abstract

Introduction: Intraductal papillary mucinous neoplasms (IPMN) represent approximately 1% of pancreatic tumors and are the most common pancreatic cystic lesions to undergo surgical resection. The aim of this work was to study the main clinical, imaging, and histological characteristics of IPMNs submitted to surgical resection at our Center. Methods: Retrospective observational study including patients with a histological diagnosis of IPMN who underwent surgical intervention between 2010 and 2022 at the Centro Hospitalar e Universitário de Coimbra (N=33). The clinical, imaging, and histopathological characteristics were collected, and the patients were divided into two groups: without adenocarcinoma (ADC) and with invasive ADC, with the aim of comparing the two groups. Statistical analysis was performed in SPSS (5% significance level). Results: Of the 33 patients, 60.6% were male, with a median age of 73 years (IQR 65-76), 42.4% underwent cephalic pancreaticoduodenectomy, and 27.3% had major postoperative complications. Sixteen patients (48.5%) had an associated ADC, of which 87.5% were stage ≤ II. Comparing patients with and without ADC: from a clinical point of view, obstructive jaundice (56.3% versus 0%, p=0.012) was associated with ADC; there was a significant difference in CA 19.9 (median 355 versus 7 U/mL, p<0.001), total bilirubin (1.45 versus 0.60 mg/dL, p=0.002) and GGT (56.50 versus 27.50 U/L, p=0.005). From an imaging point of view, the presence of a solid component (68.8% versus 11.8%, p<0.001), thickened walls with enhancement (31.25% versus 0%, p=0.008) and suspicion of malignant transformation by the Radiologist (75% versus 29.41 %, p=0.001) were associated with the presence of ADC. After a median follow-up of 24 months (IIQ 11-40), there was a statistically significant difference in overall survival between patients with and without ADC (66 versus 19 months, p=0.033).Conclusions: This study is a contribution to better identify factors associated with ADC in patients with IPMN and, consequently, with a worse prognosis. They allow for better stratification and therapeutic guidance of these patients.

Introdução: As neoplasias papilares mucinosas intraductais (IPMN) representam cerca de 1% dos tumores pancreáticos e são as lesões quísticas pancreáticas mais frequentemente submetidas a resseção cirúrgica. O objetivo deste trabalho foi estudar as principais características clínicas, imagiológicas e histológicas das IPMN submetidas a resseção cirúrgica no nosso Centro.Métodos: Estudo observacional retrospetivo incluindo doentes com diagnóstico histológico de IPMN submetidos a intervenção cirúrgica entre 2010 e 2022 no Centro Hospitalar e Universitário de Coimbra (N=33). Foram recolhidas as características clínicas, imagiológicas e histopatológicas e divididos os doentes em dois grupos: sem adenocarcinoma (ADC) e com ADC invasor, com o objetivo de comparar os dois grupos. A análise estatística foi realizada no SPSS (nível de significância de 5%). Resultados: Dos 33 doentes, 60.6% eram do sexo masculino, com uma idade mediana de 73 anos (IIQ 65-76), 42.4% foram submetidos a duodenopancreatectomia cefálica, sendo que 27.3% tiveram complicações pós-operatórias major. Dezasseis doentes (48.5%) tinham um ADC associado, dos quais 87.5% estádio ≤ II. Comparando os doentes com e sem ADC: do ponto de vista clínico, a icterícia obstrutiva (56.3% versus 0%, p=0.012) associou-se ao ADC; houve diferença significativa no CA 19.9 (mediana 355 versus 7 U/mL, p<0.001), bilirrubina total (1.45 versus 0.60 mg/dL, p=0.002) e gamaglutamiltranspeptidase (GGT) (56.50 versus 27.50 U/L, p=0.005). Do ponto de vista imagiológico, a presença de componente sólido (68.8% versus 11.8%, p<0.001), paredes espessadas com realce (31.25% versus 0%, p=0.008) e suspeita de transformação maligna pelo Radiologista (75% versus 29.41%, p=0.001) associaram-se à presença de ADC. Após uma mediana de seguimento de 24 meses (IIQ 11-40), houve uma diferença estatisticamente significativa na sobrevivência global entre os doentes com e sem ADC (66 versus 19 meses, p=0.033). Conclusões: Este estudo é um contributo para a melhor identificação dos fatores associados a ADC em doentes com IPMN e, consequentemente, com um pior prognóstico. Os mesmos permitem uma melhor estratificação e orientação terapêutica destes doentes.