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Endoscopy 2010; 42(12): 1077-1084
DOI: 10.1055/s-0030-1255971
Original article

© Georg Thieme Verlag KG Stuttgart · New York

Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms

Y.  Sawai1 , 2 , K.  Yamao2 , V.  Bhatia3 , T.  Chiba1 , N.  Mizuno2 , A.  Sawaki2 , K.  Takahashi2 , M.  Tajika4 , Y.  Shimizu5 , Y.  Yatabe6 , A.  Yanagisawa7
  • 1Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
  • 2Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
  • 3Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), Delhi, India
  • 4Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
  • 5Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
  • 6Department of Genetic Pathology, Aichi Cancer Center Hospital, Nagoya, Japan
  • 7Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan
Further Information

Publication History

submitted 12 September 2009

accepted after revision 14 July 2010

Publication Date:
30 November 2010 (online)

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Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasmsEndoscopy 2011; 43(01): 79-79
DOI: 10.1055/s-0030-1256071

Background and study aims: Side-branch intraductal papillary mucinous neoplasms (SB-IPMNs), and associated synchronous and metachronous pancreatic cancers are increasingly detected as imaging modalities become more sensitive. We investigated the natural history of SB-IPMN, and the incidence and characteristics of pancreatic cancers among patients undergoing long-term follow-up.

Patients and methods: We reviewed the clinical, imaging, and pathological features in 103 patients, diagnosed at the Aichi Cancer Center between September 1988 and September 2006 as having SB-IPMN, and conservatively followed up for ≥ 2 years (median 59 months) based on an endoscopic ultrasonography (EUS) database.

Results: 74 (71.8 %) patients had nonprogressive lesions. Overall, six patients (5.8 %) developed pancreatic cancers during follow-up, with intraductal papillary mucinous (IPM) carcinoma in four, and ductal carcinoma of pancreas that was not IPMN in two patients. Of the six pancreatic cancers, five were diagnosed at a resectable stage. The 5-year and 10-year actuarial rates of development of pancreatic cancer were 2.4 % and 20.0 %, respectively. Although, at the last follow-up, cyst size, main pancreatic duct (MPD) diameter, mural nodule size, and frequency of metachronous and/or synchronous cancers of other organs were significantly higher in patients who developed IPM carcinoma, resected SB-IPMNs without mural nodules and dilated MPDs had no IPM carcinomas.

Conclusions: The frequency of pancreatic cancers is high on long-term follow-up of SB-IPMN. Although conservative management is appropriate for selected patients, regular and long-term imaging, especially by EUS is essential, even if SB-IPMN remains unchanged for 2 years. Presence of mural nodule and dilated MPD seem to be more appropriate indicators for resection than cyst size alone for SB-IPMNs.

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K. YamaoMD 

Department of Gastroenterology
Aichi Cancer Center Hospital

1-1 Kanakoden, Chikusa-Ku
Nagoya 464-8681
Japan

Fax: +81-52-7642942

Email: kyamao@aichi-ac.jp

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