Purpose
To evaluate the experience with pancreatectomy for intraductal papillary mucinous
neoplasm (IPMN) at a single academic institution.
Methods
A prospective pancreatic database was reviewed and identified 43 patients with IPMN
who were managed operatively. Clinicopathologic features and predictors of outcome
were examined. The World Health Organization pathologic classification of IPMN was
utilized.
Results
IPMN was diagnosed in 21% of patients who underwent pancreatic resection for solid
or cystic mass lesions. Ninety-five percent of patients were symptomatic. Patients
were managed with total pancreatectomy, pancreaticoduodenectomy, distal pancreatectomy,
central pancreatectomy, or enucleation. Nine patients had adenomas, 14 had borderline
neoplasms, 10 had carcinoma in situ, and 9 had invasive carcinoma. Overall, 23 patients
(53%) had lesions with main duct involvement. Frozen section transection margins were
positive for malignancy in 2 patients. With a mean follow-up of 17 months, the 5-year
disease-specific survival for patients with main duct involvement was 67%. The 5-year
disease-specific survival for patients with benign lesions was 100%, and 61% for patients
with malignant lesions (P = .02). The presence of symptoms, increased CA 19-9, and tumor size were not predictive
of malignancy. Increased serum bilirubin concentrations were predictive of malignancy
(P = .03). Main duct involvement was also associated with malignancy (P < .02).
Conclusions
Cancer is found in 65% of patients with IMPN involving the main duct. Based on our
data, patients with symptomatic, main duct involvement, especially those with an increased
serum bilirubin, should be offered resection. Alternatively, patients with side branch
IPMN may be managed conservatively.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intraductal papillary-mucinous neoplasms of the pancreas.in: Hamilton S.R. Aaltonen L.A. World Health Organization Classification of Tumours: Tumours of the Digestive System. IARC Press, Lyon, France2000: 237-240
- Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas.Gastroenterology. 2002; 123: 1500-1507
- Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome.Ann Surg. 2004; 239: 400-408
- Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival.Ann Surg Oncol. 2006; 13: 582-594
- Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection.Ann Surg. 2004; 239: 678-685
- Intraductal papillary mucinous neoplasms of the pancreas: an updated experience.Ann Surg. 2004; 239: 788-797
- Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas.Am J Surg. 2005; 189: 632-636
- Surgical management of intraductal papillary mucinous tumor of the pancreas.Surgery. 2002; 132: 80-85
- Intraductal papillary mucinous tumors of the pancreas.JOP. 2005; 6: 112-117
- International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas.Pancreatology. 2006; 6: 17-32
- Non-parametric estimation from incomplete observations.J Am Stat Assoc. 1958; 53: 457-481
- Preoperative predictors of malignancy in pancreatic intraductal papillary mucinous neoplasms.Arch Surg. 2003; 138: 610-617
- Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients.Arch Surg. 2003; 138 (427-23)
- Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm.J Am Coll Surg. 2007; 204: 987-993
Article info
Publication history
Accepted:
July 21,
2007
Footnotes
Both A. D. Yang, MD, and L. G. Melstrom, MD, contributed equally to this manuscript.
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
