Обзор классификаций внутрипротоковых папиллярных муцинозных неоплазий, показаний к хирургическому вмешательству и его результатов

Внутрипротоковые папиллярные муцинозные неоплазии представляют собой кистозные новообразования поджелудочной железы с риском малигнизации. Обзор затрагивает современные рекомендации по лечению пациентов с этим заболеванием, показания к хирургическому вмешательству, результаты оперативного лечения и стратегии наблюдения за пациентами. В нем также освещены последние достижения в мини-инвазивной хирургии и новые биомаркеры, направленные на совершенствование распределения рисков по уровням и сокращение числа неоправданных оперативных вмешательств.

1. Ohashi K., Murakami Y., Maruyama M., Takekoshi T., Ohta H., Ohashi I. Four cases of mucous-secreting pancreatic cancer. Progr. in Dig. Endosc. 1982; 20: 348–351.

2. Del Chiaro M., Besselink M.G., Scholten L., European Study Group on Cystic Tumours of the Pancreas. European evidencebased guidelines on pancreatic cystic neoplasms. Gut. 2018; 67 (5): 789–804. https://doi.org/10.1136/gutjnl-2018-316027

3. Tanaka M., Fernández-Del Castillo C., Kamisawa T., Jang J.Y., Levy P., Ohtsuka T., Salvia R., Shimizu Y., Tada M., Wolfgang C.L. Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology. 2017; 17 (5): 738–753. https://doi.org/10.1016/j.pan.2017.07.007

4. Zhang C., Al-Shaheri F.N., Alhamdani M.S.S., Bauer A.S., Hoheisel J.D., Schenk M., Hinz U., Goedecke P., Al-Halabi K., Büchler M.W., Giese N.A., Hackert T., Roth S. Blood-Based Diagnosis and Risk Stratification of Patients with Pancreatic Intraductal Papillary Mucinous Neoplasm (IPMN). Clin. Cancer Res. 2023; 29 (8): 1535–1545. https://doi.org/10.1158/1078-0432.CCR-22-2531

5. Goh B.K., Tan D.M., Thng C.H., Lee S.Y., Low A.S., Chan C.Y., Wong J.S., Lee V.T., Cheow P.C., Chow P.K., Chung A.Y., Wong W.K., Ooi L.L. Are the Sendai and Fukuoka consensus guidelines for cystic mucinous neoplasms of the pancreas useful in the initial triage of all suspected pancreatic cystic neoplasms? A single-institution experience with 317 surgically-treated patients. Ann. Surg. Oncol. 2014; 21 (6): 1919–1926. https://doi.org/10.1245/s10434-014-3501-4

6. Djordjevic V., Knezevic D., Trotovsek B., Tomazic A., Petric M., Hadzialjevic B., Grubor N., Djokic M. Navigating Intraductal Papillary Mucinous Neoplasm Management through Fukuoka Consensus vs. European Evidence-Based Guidelines on Pancreatic Cystic Neoplasms-A Study on Two European Centers. Cancers (Basel). 2024; 16 (11): 2156. https://doi.org/10.3390/cancers16112156

7. Vege S.S., Ziring B., Jain R., Moayyedi P.; Clinical Guidelines Committee; American Gastroenterology Association. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015; 148 (4): 819–822; quize 12–3. https://doi.org/10.1053/j.gastro.2015.01.015

8. Khatkov I.E., Izrailov R.E., Khisamov A.A., Tyutyunnik P.S., Fingerhut A., Superior mesenteric-portal vein resection during laparoscopic pancreatoduodenectomy. Surg. Endosc. 2017; 31 (3): 1488–1495. https://doi.org/10.1007/s00464-016-5115-3

9. Elta G.H., Enestvedt B.K., Sauer B.G., Lennon A.M. ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts. Am. J. Gastroenterol. 2018; 113 (4): 464–479. https://doi.org/10.1038/ajg.2018.14

10. Tyutyunnik P., Klompmaker S., Lombardo C., Lapshyn H., Menonna F., Napoli N., Wellner U., Izrailov R., Baychorov M., Besselink M.G., Abu Hilal M., Fingerhut A., Boggi U., Keck T., Khatkov I.; European Consortium on Minimally Invasive Pancreatic Surgery. Learning curve of three European centers in laparoscopic, hybrid laparoscopic, and robotic pancreatoduodenectomy. Surg. Endosc. 2022; 36 (2): 1515–1526. https://doi.org/10.1007/s00464-021-08439-5

11. Marchegiani G., Pollini T., Burelli A., Han Y., Jung H.S., Kwon W., Rocha Castellanos D.M., Crippa S., Belfiori G., Arcidiacono P.G., Capurso G., Apadula L., Zaccari P., Noia J.L., Gorris M., Busch O., Ponweera A., Mann K., Demir I.E., Phillip V., Ahmad N., Hackert T., Heckler M., Lennon A.M., Afghani E., Vallicella D., Dall'Olio T., Nepi A., Vollmer C.M., Friess H., Ghaneh P., Besselink M., Falconi M., Bassi C., Goh B.K., Jang J.Y., Fernández-Del Castillo C., Salvia R. Surveillance for Presumed BD-IPMN of the Pancreas: Stability, Size, and Age Identify Targets for Discontinuation. Gastroenterology. 2023; 165 (4): 1016–1024.e5. https://doi.org/10.1053/j.gastro.2023.06.022

12. Davis C.H., Choubey A.P., Langan R.C., Grandhi M.S., Kennedy T.J., August D.A., Alexander H.R., Pitt H.A. Pancreatectomy for intraductal papillary mucinous neoplasm: has anything changed in North America? HPB (Oxford). 2024; 26 (1): 109–116. https://doi.org/10.1016/j.hpb.2023.09.001

13. Leonhardt C.S., Hinz U., Kaiser J., Hank T., Tjaden C., Bergmann F., Hackert T., Büchler M.W., Strobel O. Presence of low-grade IPMN at the pancreatic transection margin does not have prognostic significance after resection of IPMN-associated pancreatic adenocarcinoma. Eur. J. Surg. Oncol. 2023; 49 (1): 113–121. https://doi.org/10.1016/j.ejso.2022.08.003

14. Addeo P., Canali G., Paul C., de Mathelin P., Averous G., Bachellier P. Long-term survival after resection of invasive pancreatic intraductal papillary mucinous neoplasm. Langenbecks Arch. Surg. 2024; 409 (1): 361. https://doi.org/10.1007/s00423-024-03550-2

15. Ohtsuka T., Fernandez-Del Castillo C., Furukawa T., Hijioka S., Jang J.Y., Lennon A.M., Miyasaka Y., Ohno E., Salvia R., Wolfgang C.L., Wood L.D. International evidence-based Kyoto guidelines for the management of intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2024; 24 (2): 255–270. https://doi.org/10.1016/j.pan.2023.12.009

16. Salahuddin A., Thayaparan V., Hamad A., Tarver W., Cloyd J.M., Kim A.C., Gebhard R., Pawlik T.M., Reames B.N., Ejaz A. Recurrence following Resection of Intraductal Papillary Mucinous Neoplasms: A Systematic Review to Guide Surveillance. J. Clin. Med. 2024; 13 (3): 830. https://doi.org/10.3390/jcm13030830

17. Crippa S., Bassi C., Salvia R., Malleo G., Marchegiani G., Rebours V., Levy P., Partelli S., Suleiman S.L., Banks P.A., Ahmed N., Chari S.T., Fernández-Del Castillo C., Falconi M. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing nonoperative management: a mid-term follow-up analysis. Gut. 2017; 66 (3): 495–506. https://doi.org/10.1136/gutjnl-2015-310162

18. Abdalla T.S.A., Duhn J., Klinkhammer-Schalke M., Zeissig S.R., Kleihues-van Tol K., Honselmann K.C., Braun R., Kist M., Bolm L., von Fritsch L., Lapshyn H., Litkevych S., Hummel R., Zemskov S., Wellner U.F., Keck T., Deichmann S. Oncological Outcomes and Patterns of Recurrence after the Surgical Resection of an Invasive Intraductal Papillary Mucinous Neoplasm versus Primary Pancreatic Ductal Adenocarcinoma: An Analysis from the German Cancer Registry Group of the Society of German Tumor Centers. Cancers (Basel). 2024; 16 (11): 2016. https://doi.org/10.3390/cancers16112016/.