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.