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Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate?
  1. Roberto Salvia1,
  2. Stefano Crippa1,
  3. Massimo Falconi1,
  4. Claudio Bassi1,
  5. Alessandro Guarise2,
  6. Aldo Scarpa3,
  7. Paolo Pederzoli1
  1. 1Department of Surgery, University of Verona, Policlinico “GB Rossi”, Piazzale LA Scuro, Verona, Italy
  2. 2Department of Radiology, University of Verona, Policlinico “GB Rossi”, Piazzale LA Scuro, Verona, Italy
  3. 3Department of Pathology, University of Verona, Policlinico “GB Rossi”, Piazzale LA Scuro, Verona, Italy
  1. Correspondence to:
    Dr C Bassi
    Department of Surgery, University of Verona, Policlinico “GB Rossi”, Piazzale LA Scuro 10, 37134 Verona, Italy; claudio.bassi{at}


Background: Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas are reported to be less aggressive than the main-duct type. Hence, less aggressive treatment has been proposed for the former.

Aim: To evaluate the effectiveness of a follow-up protocol for BD-IPMNs.

Design: Prospective study.

Setting: An academic tertiary referral centre.

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, carbohydrate antigen 19.9 level >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: The effectiveness of conservative management of BD-IPMNs.

Results: 20 (18.3%) patients underwent surgery (arm A); pathological diagnosis of BD-IPMNs was always confirmed. 89 (81.7%) patients were followed up for a median of 32 months (arm B); of these, 57 (64%) patients had multifocal disease. After a mean follow-up of 18.2 months, 5 (5.6%) patients showed an increase in lesion size and underwent surgery. The pathological diagnosis was branch-duct adenoma in three patients and borderline adenoma in two.

Conclusions: Surgery is indicated in <20% of cases 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 observation for a longer time is needed to confirm these results, our findings support the guidelines recently recommended by the International Association of Pancreatology.

  • BD-IPMN, branch-duct intraductal papillary mucinous neoplasm
  • CA, carbohydrate antigen
  • CEUS, contrast-enhanced abdominal ultrasonography
  • ERCP, endoscopic retrograde cholangiopancreatography
  • EUS, endoscopic ultrasound
  • IAP, International Association of Pancreatology
  • MD-IPMN, main-duct intraductal papillary mucinous neoplasm
  • MRCP, magnetic resonance cholangiopancreatography
  • US, ultrasound

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  • Published Online First 23 November 2006

  • Funding: This work was funded by the Fondazione Zanotto per il Pancreas (to PP), the Associazione Italiana per la Ricerca sul Cancro (to AS), the Ministero dell’ Università e della Ricerca Scientifica (to CB and AS), the European Community’s FP6 funding (Contract LSHB-CT-2006-018771) and the Fondazione Italiana per le Malattie del Pancreas.

  • Competing interests: None.

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