Clinical surgery-International
Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts

This work was presented in part at the 2006 joint Meeting of the American Pancreatic Association and the International Association of Pancreatology, Chicago, IL, November 1 to 4, 2006
https://doi.org/10.1016/j.amjsurg.2008.10.022Get rights and content

Abstract

Introduction

The appropriate management of patients with branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with multiple involvements of branch ducts (multifocal BD-IPMN) remains challenging.

Patients and methods

Our database of patients affected by IPMN was queried to identify patients with a clinicoradiologic or a pathologic diagnosis of multifocal BD-IPMN between January 1990 and December 2006.

Results

One hundred thirty-one patients (52 male and 79 female; median age 67 years) had a clinicoradiologic or a histopathologic diagnosis of multifocal BD-IPMN. Ten patients (7.6%) underwent surgery. After a median follow-up of 40 months (range 12 to 127) all the 121 patients conservatively managed are alive, and none underwent surgery during follow-up. One patient with invasive carcinoma developed hepatic metastases and died of disease 88 months after surgery.

Comments

Patients with branch-side IPMN can be conservatively managed, but when multifocality is present follow-up may be problematic because of the number of lesions to be evaluated. The nonoperative management of well-selected patients with BD-IPMN, even in the multifocal setting, seems to be safe and reliable.

Section snippets

Patients and Methods

A prospective database of patients with IPMN was maintained at the Department of Surgery of the University of Verona and was queried to identify patients with a clinicoradiologic or pathologic diagnosis of multifocal BD-IPMN who were observed between January 1990 and December 2006.

Past medical history, radiologic workup, laboratory assessment, and clinical features, as well as histologic diagnosis and pathology data, if any, were recorded. Resected neoplasms were classified according to the

Demographic, clinical, and laboratory findings

During the study period, 131 patients (52 male and 79 female; median age of 67 years [range 46 to 84]) had a clinicoradiologic or histopathologic diagnosis of multifocal BD-IPMN, and they were the focus of the present study.

In all, 129 patients (98.5%) were completely asymptomatic, and their neoplasms were incidentally discovered during workup for other reasons. Two patients (1.5%) complained of abdominal pain, and 4 patients (3%) had diabetes at the time of diagnosis, but none of them had

Patients conservatively managed

After median follow-up of 40 months (range 12 to 127), all 121 patients (92.4%) who were conservatively managed are currently alive. None of them underwent surgery during follow-up. They remain asymptomatic, with no nodules in the lesions and no increase of the diameter >3.5 cm.

Patients surgically treated

The median follow-up was 56.5 months (range 13 to 105) for patients who underwent surgical resection. The patient with invasive carcinoma developed hepatic metastases and died from his disease 88 months after initial

Comments

IPMNs are a relatively new entity within pancreatic diseases. Described for the first time in 1982 as “mucin-producing cancer,”1 it took almost 10 years for them to be widely recognized.13 It has been clearly demonstrated that IPMNs originate from the epithelium of the main pancreatic duct or from its branches, and they can evolve through different biologic stages, from adenoma to invasive carcinoma. They can affect any part of the gland, but preferentially they arise in the head or uncinate

Acknowledgments

This study was supported by the Fondazione Italiana Malattie Pancreas.

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