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Real-world costs and dynamics of surveillance in patients who underwent surgery for low-risk branch duct intraductal papillary mucinous neoplasms

  • Author Footnotes
    1 These authors share the first authorship.
    Domenico Tamburrino
    Footnotes
    1 These authors share the first authorship.
    Affiliations
    Division of Pancreatic and Transplant Surgery, Vita Salute San Raffaele University, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
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  • Author Footnotes
    1 These authors share the first authorship.
    Paolo Cortesi
    Footnotes
    1 These authors share the first authorship.
    Affiliations
    Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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  • Rita Facchetti
    Affiliations
    Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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  • Nicolò de Pretis
    Affiliations
    Department of Gastroenterology, Verona, Italy
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  • Enrique Pérez-Cuadrado-Robles
    Affiliations
    Department of Hepato-Gastroenterology, Cliniques universitaires Saint-Luc, Brussels, Belgium

    Department of Gastroenterology, Hôpital européen Georges-Pompidou, Paris, France
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  • Laura Uribarri-Gonzalez
    Affiliations
    Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain

    Department of Gastroenterology, Hospital Universitario de Santiago de Compostela, Santiago de Compostela, Spain
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  • Zeeshan Ateeb
    Affiliations
    Pancreatic Surgery Unit, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Universitetsjukhuset i Huddinge, Huddinge, Sweden
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  • Giulio Belfiori
    Affiliations
    Division of Pancreatic and Transplant Surgery, Vita Salute San Raffaele University, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
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  • Paolo Giorgio Arcidiacono
    Affiliations
    Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
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  • Lorenzo Giovanni Mantovani
    Affiliations
    Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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  • Marco Del Chiaro
    Affiliations
    Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Denver, CO, United States
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  • Johanna Laukkarinen
    Affiliations
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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  • Massimo Falconi
    Affiliations
    Division of Pancreatic and Transplant Surgery, Vita Salute San Raffaele University, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
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  • Stefano Crippa
    Correspondence
    Corresponding author. Division of Pancreatic Surgery, Vita -Salute San Raffaele University, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
    Affiliations
    Division of Pancreatic and Transplant Surgery, Vita Salute San Raffaele University, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
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  • Author Footnotes
    2 These authors share the senior authorship
    Gabriele Capurso
    Footnotes
    2 These authors share the senior authorship
    Affiliations
    Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Milan, Italy
    Search for articles by this author
  • Author Footnotes
    1 These authors share the first authorship.
    2 These authors share the senior authorship
Published:August 30, 2022DOI:https://doi.org/10.1016/j.ejso.2022.08.033

      Abstract

      Surveillance costs and appropriateness of surgery of “low-risk” BD-IPMNs are relevant issues. In this study we evaluated the rate of correct indication for pancreatectomy defined as high grade dysplasia (HGD) at histology in 961 patients who underwent surveillance for a median of 5.1 years. Undertreatment and overtreatment were defined as invasive cancer and low grade dysplasia (LGD) at histology, respectively. Of the 66 patients (6.9%) who were operated, only 16 (23.8%) had a HGD while 40 (59.7%) had a LGD and 10 (14.9%) an invasive cancer, without differences regarding timing of surgery. The mean surveillance cost was € 194.9 ± 107.6 per patient-year, with a median cost of € 277.1 ± 148.2 in the correct surgery group compared with € 222.7 ± 111.6 and € 197 ± 102.7 in the overtreatment and undertreatment groups. The surveillance mean cost from diagnosis to surgery was € 854.8. Rate of appropriate surgery in BD-IPMNs under surveillance is low.

      Keywords

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