Is Surgery in Autoimmune Pancreatitis Always a Failure?
Abstract
:1. Introduction
2. Autoimmune Pancreatitis as a Diagnostic Challenge
3. Surgical Experience in Autoimmune Pancreatitis
4. Consideration of Surgical Treatment in Autoimmune Pancreatitis
5. Our Experience
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Study (Study Period) | Study Cohort | AIP Type | Symptoms | Imaging | IgG4 a | CA 19-9 a | Preoperative Biopsy a | Concurrent Malignancy | IgG4-Related OOI | Follow-Up | Relapse |
---|---|---|---|---|---|---|---|---|---|---|---|
Detlefsen, 2012 (1987–2010) | 114 pts with AIP | 1: 63 (55.3%) 2: 51 (44.7%) | NS | NS | Assessed in 29 pts (25.4%) Postop ↑ in 1: 12/18 (66.7%) 2: 1/11 (9.1%) | NS | NS | None | 1: 33/63 (52.4%) 2: 6/51 (11.8%) | 5.3 y (mean) | 1: 21/51 (41.2%) 2: 6/39 (15.4%) |
van Heerde, 2012 (2000–2009) | 7 pts with AIP among 274 PDs (2.6%) | 1: 2 (28.5%) 2: 4 (57.2%) AIC: 1 (14.3%) | Jaundice 86% Weight loss 2.7 kg (mean) Abdominal pain 29% Recent onset diabetes (29%) | No typical imaging findings were revealed in any of the patients | Preop ↑ in 1/3 (33%/42.9%) | Preop ↑ in 3/7 (43%/100%) | EUS FNA performed in 1 pt which was suspicious for malignancy (14.3%) | NS | 1: 2 (100%) 2: none | NS | NS |
Miura, 2013 (1990–2010) | 13 pts with AIP compared to 29 pts with CP | All type 1 | Abdominal pain (46%) Jaundice (23%) | Focal MPD stricture 10 pts (77%) MPD dilatation 6 pts (46%) Pancreatic enlargement 8 pts (62%, 5 focal, 3 diffuse) | Preop ↑ in 1/3 (33%/23.1%) Postop ↑ in 2/3 (66%/23.1%) | NS | NS | None | None | 45.6 mo (median) | None |
Clark, 2013 (1986–2011) | 74 pts with AIP | 1: 34 (46%) 2: 29 (39%) Unknown: 11 (15%) | Jaundice (46%) Weight loss (45%) Pancreatitis (34%) | MPD dilatation 24 pts (32%) Pancreatic enlargement-diffuse 14 pts (19%) Pancreatic mass 52 pts (70%) | Preop assessed in 10 (14%), 64 mg/dL (median) | Preop assessed in 41 (55%), 17 U/mL (median) | 4 pts (5%) had preoperative biopsy indicating malignancy | None | NS | 58.4 mo (median) | Total: 11/66 (17%) 1: 7 (25%) 2: 3 (11%) |
Ikeura, 2014 (1996–2012) | 30 pts with AIP | 1: 23 (77%) 2: 7 (23%) | Jaundice (57%) Abdominal pain (37%) Weight loss (33%) | Long or multiple MPD strictures 9 pts (30%) Focal MPD stricture 13 pts (43%) Pancreatic enlargement-focal 19 pts (63%) Pancreatic mass 11 pts (37%) Capsule-like rim 1 pt (3%) | Pre- or postop ↑ in 11/23 (48%/76.7%) 3 pts (13%) >2x upper limit | NS | None | None | 1: 8 (35%)—3 pts developed OOI after surgery | NS | 1: 4 (57%) 2: none |
Vitali, 2014 (2005–2011) | 11 pts with AIP among 373 pancreatic resections (2.9%) | 1: 8 (73%) 2: 3 (27%) | Abdominal pain (64%) Weight loss (64%) Jaundice (36%) Acute pancreatitis (27%) | NS | NS | NS | NS | None | NS | NS | NS |
Macinga, 2017 (2000–2013) | 15 pts with AIP among 295 pancreatic resections (5.1%) | 1: 6 (40%) 2: 9 (60%) | Weight loss (80%) Jaundice (47%) Recent onset diabetes (33%) | Atypical imaging findings 9 pts (60%) L2 evidence acc. to ICDC 6 pts (40%) | Preop normal in 1: 3/3 (100%/20%) | Pts without PDAC 35.2 kU/L (mean) Pts with PDAC 89.8 kU/L (mean) | EUS FNA performed in 11 pts (73.3%) True positive 3 pts (27.3%, AIP + PDAC) Inconclusive 2 pts (18.2%, 1 with AIP + PDAC) True negative 4 pts (36.4%) False positive 2 pts (18.2%) | 6 (40%) with PDAC | 1: 2 (13%)—after surgery | NS | NS |
Dickerson, 2019 (1997–2016) | 45 pts with AIP, 27 underwent surgery | 1: 16 (59.3%) 2: 9 (33.3%) NOS: 2 (7.4%) | NS | MPD stricture 5 pts (20%) MPD dilatation 3 pts (12%) Pancreatic enlargement-focal 6 pts (24%), diffuse 14 pts (56%) Pancreatic mass 4 pts (16%) Capsule-like rim 0 pts (0%) Double duct sign 3 pts (12%) | ↑ in 2/11 (18.2%/24.4%) | ↑ in 12/26 (46.2%/96.3%) | Of the EUS FNA performed, none confirmed or suggested AIP | 3 pts (11.1%)—2 with PDAC and 1 with solid pseudopapillary neoplasm | NS | NS | None |
Javed, 2021 (2001–2006) | 56 pts with AIP among 5709 pancreatic resections (0.9%) compared to 32 pts with AIP managed conservatively | All type 1 | Jaundice (64.3%) Abdominal pain (62.5%) Weight loss (53.6%) | MPD dilatation 15 pts (26.8%) Pancreatic enlargement 16 pts (28.6%) Pancreatic mass 32 pts (57.1%) Pancreatic atrophy 6 pts (10.7%) | ↑ in 6/23 (26.1%/41.1%), 34.1 mg/dl (median) | ↑ in 16/31 (51.6%/55.4%), 40 U/mL (median) | Preoperative biopsy in 38 pts (67.9%) Nondiagnostic in 18 pts (51.4%) PDAC in 11 pts (31.4%) CP in 4 pts (11.4%) Cellular atypia in 3 pts (8.6%) | 1 pt with occult PDAC, 15 pts (27.3%) with PanINs | NS | 14.8 mo (median) | 6 (10.7%) |
Nikolic, 2022 (2001–2020) | 159 pts with AIP, 35 underwent surgery | 1: 28 (80%) 2: 7 (20%) | Abdominal pain (48.6%) Weight loss (48.6%) Jaundice (42.9%) | MPD stricture 1 pt (2.9%) Pancreatic mass 19 pts (54.3%) Double duct sign 1 pt (2.9%) | Preop ↑ in 7/20 (35%/20%) 1 pt (5%) >3x upper limit | Preop ↑ in 5/20 (25%/57.1%) | EUS FNA performed in 2 pts—1 with benign features, 1 inconclusive Brush cytology performed in 10 pts with benign features (28.6%) | 8 pts (22.9%)—2 with PDAC, 2 with MCN (1 with HGD), 4 with IPMN (1 with HGD) | 25 (71.4%) | 50 mo (median) | 1: 9 (36%) 2: none |
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Zavrtanik, H.; Tomažič, A. Is Surgery in Autoimmune Pancreatitis Always a Failure? Medicina 2023, 59, 193. https://doi.org/10.3390/medicina59020193
Zavrtanik H, Tomažič A. Is Surgery in Autoimmune Pancreatitis Always a Failure? Medicina. 2023; 59(2):193. https://doi.org/10.3390/medicina59020193
Chicago/Turabian StyleZavrtanik, Hana, and Aleš Tomažič. 2023. "Is Surgery in Autoimmune Pancreatitis Always a Failure?" Medicina 59, no. 2: 193. https://doi.org/10.3390/medicina59020193