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Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Results of a prospective protocol on the management of 109 consecutive patients.
  1. Roberto Salvia (roberto.salvia{at}univr.it)
  1. Department of Surgery, University of Verona, Italy
    1. Stefano Crippa (ste.crippa{at}libero.it)
    1. Department of Surgery, University of Verona, Italy
      1. Massimo Falconi (massimo.falconi{at}univr.it)
      1. Department of Surgery, University of Verona, Italy
        1. Claudio Bassi (claudio.bassi{at}univr.it)
        1. Department of Surgery, University of Verona, Italy
          1. Alessandro Guarise (scrippa{at}partners.org)
          1. Department of Radiology, University of Verona, Italy
            1. Aldo Scarpa (aldo.scarpa{at}univr.it)
            1. Department of Pathology, University of Verona, Italy
              1. Paolo Pederzoli (paolo.pederzoli{at}univr.it)
              1. Department of Surgery, University of Verona, Italy

                Abstract

                Objective: Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas are reported to be less aggressive compared to main-duct type; thus, less aggressive treatment has been proposed. Aim of this study was to evaluate the effectiveness of a follow up protocol for BD-IPMNs.

                Design: Prospective study.

                Setting: Academic tertiary referral center.

                Patients: From 2000 to 2003, 109 patients with BD-IPMNs underwent trans-abdominal ultrasound and magnetic resonance cholangiopancreatography with secretin. Patients who presented malignancy-related parameters (size >3,5 cm, nodules, thick walls, CA 19.9 >25 U/l, recent-onset or worsened diabetes) and/or complained of symptoms were submitted to surgery (Arm A). All asymptomatic patients without suspicion of malignancy were followed up according to a 6-month clinical-radiological protocol (Arm B).

                Main outcome measures: Effectiveness of conservative management of BD-IPMNs.

                Results: Twenty patients (18.3%) underwent surgery (Arm A); pathological diagnosis of BD-IPMNs was always confirmed. Eighty-nine patients (81.7%) were followed up for a median of 32 months (Arm B); of these, 57 (64%) had multifocal disease. After a mean follow-up of 18.2 months, 5 patients (5.6%) showed an increase in lesion size and underwent surgery. The pathological diagnosis was branch-duct adenoma in three patients and borderline in two.

                Conclusions: Surgery is indicated in less than 20% of BD-IPMNs, and in the absence of malignancy-related parameters, careful non-operative management seems to be safe and effective in asymptomatic patients. Although a longer observation is needed to confirm these results, our findings support the guidelines recently recommended by IAP.

                • branch duct,
                • follow up
                • intraductal papillary mucinous neoplasms
                • magnetic resonance
                • surgery

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