{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T22:41:36Z","timestamp":1773009696888,"version":"3.50.1"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>\n                      This meta\u2010analysis aims to evaluate the efficacy of adjuvant\n                      <jats:italic>therapy<\/jats:italic>\n                      (ADJ) in patients with resected invasive IPMNs, compared with follow\u2010up (FUP).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A random effects meta\u2010analysis was performed. Meta\u2010regression analysis was used to clarify heterogeneity. The trial sequential analysis was used to test Type I and Type II errors, defining the required information size (RIS). The primary endpoint was OS, and the secondary endpoint was DFS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The accrued sample size (AIS) was 2422 patients for OS and 493 patients for DFS. OS and DFS in the ADJ arm were similar to the FUP arm (HR 1.21; 95% CI 0.81\u22121.79,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.349 and HR 0.98; 95% CI 0.64\u22121.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.936). The RIS were 2422 for OS and 254 for DFS, allowing the exclusion of Type II errors. For the primary endpoint, heterogeneity was high (I\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a098%). Meta\u2010regression analysis showed that, although considering two groups equal for confounding covariates, OS in the ADJ and FUP arms remains similar. A subgroup analysis showed that node\u2010positive patients have improved OS after adjuvant\n                      <jats:italic>therapy<\/jats:italic>\n                      administration (HR 1.86; 95% CI 1.39; 2.47,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Adjuvant\n                      <jats:italic>therapy<\/jats:italic>\n                      should not be administered indiscriminately to all patients. Node\u2010positive invasive IPMN seems to have an improved OS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>PROSPERO 2024 CRD42024561326<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70187","type":"journal-article","created":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T16:24:56Z","timestamp":1765124696000},"page":"196-203","source":"Crossref","is-referenced-by-count":0,"title":["Does Adjuvant\n                    <i>Therapy<\/i>\n                    in Invasive Intraductal Papillary Mucinous Neoplasm of the Pancreas Improve Survival? A Systematic Review and Meta\u2010Analysis Using Trial Sequential Analysis"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0478-9024","authenticated-orcid":false,"given":"Carlo","family":"Ingaldi","sequence":"first","affiliation":[{"name":"Division of Pancreatic Surgery IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5859-1543","authenticated-orcid":false,"given":"Vincenzo","family":"D'Ambra","sequence":"additional","affiliation":[{"name":"Division of Pancreatic Surgery IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"},{"name":"Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum University of Bologna S. Orsola\u2010Malpighi Hospital  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudio","family":"Ricci","sequence":"additional","affiliation":[{"name":"Division of Pancreatic Surgery IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"},{"name":"Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum University of Bologna S. Orsola\u2010Malpighi Hospital  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Alberici","sequence":"additional","affiliation":[{"name":"Division of Pancreatic Surgery IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Migliori","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariacristina","family":"Di Marco","sequence":"additional","affiliation":[{"name":"Division of Oncology IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Palloni","sequence":"additional","affiliation":[{"name":"Division of Oncology IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Mosconi","sequence":"additional","affiliation":[{"name":"Division of Radiology IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Serra","sequence":"additional","affiliation":[{"name":"Division of Interventional Ultrasound IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Casadei","sequence":"additional","affiliation":[{"name":"Division of Pancreatic Surgery IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna  Bologna Italy"},{"name":"Department of Internal Medicine and Surgery (DIMEC), Alma Mater Studiorum University of Bologna S. 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