TY - JOUR
T1 - Prophylactic total pancreatectomy in individuals at high risk of pancreatic ductal adenocarcinoma (PROPAN): systematic review and shared decision-making programme using decision tables
AU - Scholten, Lianne
AU - Latenstein, Anouk E. J.
AU - Aalfs, Cora M.
AU - Bruno, Marco J.
AU - Busch, Olivier R.
AU - Bonsing, Bert A.
AU - Koerkamp, Bas Groot
AU - Molenaar, I. Quintus
AU - Ubbink, Dirk T.
AU - van Hooft, Jeanin E.
AU - Fockens, Paul
AU - Dutch Pancreatic Cancer Group
AU - Glas, Jolanda
AU - DeVries, J. Hans
AU - Besselink, Marc G.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background: Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm, may wish to discuss prophylactic total pancreatectomy but strategies to do so are lacking. Objective: To develop a shared decision-making programme for prophylactic total pancreatectomy using decision tables. Methods: Focus group meetings with patients were used to identify relevant questions. Systematic reviews were performed to answer these questions. Results: The first tables included hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm. No studies focused on prophylactic total pancreatectomy in these groups. In 52 studies (3570 patients), major morbidity after total pancreatectomy was 25% and 30-day mortality was 6%. After minimally invasive total pancreatectomy (seven studies, 35 patients) this was, respectively, 13% and 0%. Exocrine insufficiency-related symptoms occurred in 33%. Quality of life after total pancreatectomy was slightly lower compared with the general population. Conclusion: The decision tables can be helpful for discussing prophylactic total pancreatectomy with individuals at high risk of pancreatic ductal adenocarcinoma.
AB - Background: Individuals with a very high lifetime risk of developing pancreatic ductal adenocarcinoma; for example, hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm, may wish to discuss prophylactic total pancreatectomy but strategies to do so are lacking. Objective: To develop a shared decision-making programme for prophylactic total pancreatectomy using decision tables. Methods: Focus group meetings with patients were used to identify relevant questions. Systematic reviews were performed to answer these questions. Results: The first tables included hereditary pancreatitis and main-duct or mixed-type intraductal papillary mucinous neoplasm. No studies focused on prophylactic total pancreatectomy in these groups. In 52 studies (3570 patients), major morbidity after total pancreatectomy was 25% and 30-day mortality was 6%. After minimally invasive total pancreatectomy (seven studies, 35 patients) this was, respectively, 13% and 0%. Exocrine insufficiency-related symptoms occurred in 33%. Quality of life after total pancreatectomy was slightly lower compared with the general population. Conclusion: The decision tables can be helpful for discussing prophylactic total pancreatectomy with individuals at high risk of pancreatic ductal adenocarcinoma.
KW - Pancreatic ductal adenocarcinoma
KW - cancer risk
KW - diabetes mellitus
KW - hereditary pancreatitis
KW - intraductal papillary mucinous neoplasm
KW - mutation
KW - prophylactic total pancreatectomy
UR - http://www.scopus.com/inward/record.url?scp=85088453082&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/2050640620945534
DO - https://doi.org/10.1177/2050640620945534
M3 - Review article
C2 - 32703081
SN - 2050-6406
VL - 8
SP - 865
EP - 877
JO - United European gastroenterology journal
JF - United European gastroenterology journal
IS - 8
ER -