Abstract
Background
International consensus guidelines have informed the management of intraductal papillary mucinous neoplasms (IPMNs) and introduced high risk stigmata and worrisome features that risk stratify lesions beyond only cyst size. In this study, we sought to understand whether these clinical considerations have impacted surgical selection criteria at United States hospitals.Methods
The National Cancer Database (2004-2021) was queried to identify all patients that underwent resection for non-invasive and invasive IPMNs. Patients with missing cyst size data were excluded. The cohort was divided into time periods reflecting the succession of IAP guidelines: Pre-Fukuoka (2004-2011), Fukuoka (2012-2016), Revised Fukuoka (2017-2021).Results
Of 3,580 resected IPMNs, invasive pathology was identified in 44% of all lesions, increasing to 48% when applying the Revised Fukuoka guidelines (Fukuoka 40%, Pre-Fukuoka 43%, pConclusions
The size of resected noninvasive IPMNs has increased over time, whereas the size of invasive lesions has progressively decreased. This trend may reflect improved, guideline concordant recognition of malignant risk features, including reduced reliance on cyst size alone.