Surveillance of Individuals at High Risk of Developing Pancreatic Cancer: A Prevalence meta-analysis to Estimate the Rate of low-yield Surgery.

Journal

Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354

Informations de publication

Date de publication:
08 Sep 2023
Historique:
medline: 8 9 2023
pubmed: 8 9 2023
entrez: 8 9 2023
Statut: aheadofprint

Résumé

To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance. Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRI) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well-quantified. A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the CAPS goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals (PROSPERO: #CRD42022300408). Twenty-three articles with 5,027 patients (median 109 patients/study, IQR 251) were included. The pooled prevalence of low-yield surgery was 2.1% [95%CI 0.9-3.7], I2 83%). In the subgroup analysis, this prevalence was non-significantly higher in studies that only included familial pancreatic cancer (FPC) subjects without known pathogenic variants (PV), compared to those enrolling PV carriers. No effect modifiers were found. Overall, the pooled prevalence of subjects under surveillance who had a pancreatic resection that contained target lesions was 0.8% [95%CI 0.3-1.5], I2 24%). The temporal analysis showed that the rate of low-yield surgeries decreased in the last decades and stabilized at around 1% (test for subgroup differences P<0.01). The risk of "low-yield" surgery during pancreatic cancer surveillance is relatively low but should be thoroughly discussed with individuals under surveillance.

Sections du résumé

OBJECTIVE OBJECTIVE
To quantify the rate of low-yield surgery, defined as no high-grade dysplastic precursor lesions or T1N0M0 pancreatic cancer at pathology, during pancreatic cancer surveillance.
SUMMARY BACKGROUND DATA BACKGROUND
Global efforts have been made in pancreatic cancer surveillance to anticipate the diagnosis of pancreatic cancer at an early stage and improve survival in high-risk individuals (HRI) with a hereditary predisposition. The negative impact of pancreatic cancer surveillance when surgery is performed for low-grade dysplasia or a non-neoplastic condition is not well-quantified.
METHODS METHODS
A systematic search and prevalence meta-analysis was performed for studies reporting surgery with final diagnoses other than those defined by the CAPS goals from January 2000 to July 2023. The secondary outcome was the pooled proportion of final diagnoses matching the CAPS goals (PROSPERO: #CRD42022300408).
RESULTS RESULTS
Twenty-three articles with 5,027 patients (median 109 patients/study, IQR 251) were included. The pooled prevalence of low-yield surgery was 2.1% [95%CI 0.9-3.7], I2 83%). In the subgroup analysis, this prevalence was non-significantly higher in studies that only included familial pancreatic cancer (FPC) subjects without known pathogenic variants (PV), compared to those enrolling PV carriers. No effect modifiers were found. Overall, the pooled prevalence of subjects under surveillance who had a pancreatic resection that contained target lesions was 0.8% [95%CI 0.3-1.5], I2 24%). The temporal analysis showed that the rate of low-yield surgeries decreased in the last decades and stabilized at around 1% (test for subgroup differences P<0.01).
CONCLUSIONS CONCLUSIONS
The risk of "low-yield" surgery during pancreatic cancer surveillance is relatively low but should be thoroughly discussed with individuals under surveillance.

Identifiants

DOI: 10.1097/SLA.0000000000006094 PMID: 37681303
pubmed: 37681303
doi: 10.1097/SLA.0000000000006094
pii: 00000658-990000000-00641
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

The authors report no conflicts of interest.

Auteurs

Salvatore Paiella (S)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Erica Secchettin (E)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Gabriella Lionetto (G)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Livia Archibugi (L)

Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan Italy.

Danila Azzolina (D)

Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy.

Fabio Casciani (F)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Diane M Simeone (DM)

Department of Surgery, New York University, New York, New York, USA.
Perlmutter Cancer Center, New York University, New York, New York, USA.

Kasper A Overbeek (KA)

Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.

Michael Goggins (M)

Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Medicine, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA.

James Farrell (J)

Yale Center for Pancreatic Disease, Yale University School of Medicine, New Haven, CT, USA.

Ruggero Ponz de Leon Pisani (R)

Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan Italy.

Maddalena Tridenti (M)

Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan Italy.

Maria Assunta Corciulo (MA)

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy.

Giuseppe Malleo (G)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Paolo Giorgio Arcidiacono (PG)

Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan Italy.

Massimo Falconi (M)

School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Pancreatic Surgery and Transplantation Unit, Pancreas Translational and Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Dario Gregori (D)

Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padova, Padova, Italy.

Claudio Bassi (C)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Roberto Salvia (R)

General and Pancreatic Surgery Unit, Pancreas Institute, University of Verona, Verona, Italy.

Gabriele Capurso (G)

Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita Salute San Raffaele University, Milan Italy.

Classifications MeSH