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Clinical Management and Surgical Decision-Making of IPMN of the Pancreas

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Pancreatic Cancer

Part of the book series: Methods in Molecular Biology ((MIMB,volume 1882))

Abstract

Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic neoplasm (PCN). The increased attention to IPMN is due to its unique features of malignant progression, being different between main duct IPMN and branch duct IPMN, and increased de novo development of conventional pancreatic ductal adenocarcinoma elsewhere in the pancreas. The increased interest in IPMN led to publication of many guidelines on its clinical management. This chapter aims to summarize and compare characteristics of nine guidelines on the clinical management of IPMN and other PCNs published in the English literature and further to show a current strategy for surgical decision making in the management of IPMN.

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References

  1. Werner J, Fritz S, Buchler MW (2012) Intraductal papillary mucinous neoplasms of the pancreas: a surgical disease. Nat Rev Gastroenterol Hepatol 9:253–259

    Article  CAS  Google Scholar 

  2. Reid-Lombardo KM, St Sauver J, Li Z et al (2008) Incidence, prevalence, and management of intraductal papillary mucinous neoplasm in Olmsted County, Minnesota, 1984-2005: a population study. Pancreas 37:139–144

    Article  Google Scholar 

  3. de Jong K, Nio CY, Hermans JJ et al (2010) High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 8:806–811

    Article  Google Scholar 

  4. Sey MSL, Teagarden S, Settles D et al (2015) Prospective cross-sectional study of the prevalence of incidental pancreatic cysts during routine outpatient endoscopic ultrasound. Pancreas 44:1130–1133

    Article  Google Scholar 

  5. Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32

    Article  Google Scholar 

  6. Yamaguchi K, Ohuchida J, Ohtsuka T et al (2002) Intraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas. Pancreatology 2:484–490

    Article  Google Scholar 

  7. Tanaka M (2011) Controversies in the management of pancreatic IPMN. Nat Rev Gastroenterol Hepatol 8:56–60

    Article  Google Scholar 

  8. Jacobson BC, Baron TH, Douglas G et al (2005) ASGE guideline: the role of endoscopy in the diagnosis and the management of cystic lesions and inflammatory fluid collections of the pancreas. Gastrointest Endosc 61:363–370

    Article  Google Scholar 

  9. Tanaka M, Fernandez del Castillo C, Adsay V et al (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12:183–197

    Article  Google Scholar 

  10. Tanaka M, Fernández-del Castillo C, Kamisawa T et al (2018) Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 17(5):738–753 in press

    Article  Google Scholar 

  11. Jang JY, Park T, Lee S et al (2014) Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms. Br J Surg 101:686–692

    Article  CAS  Google Scholar 

  12. Goh BK, Thng CH, Tan DM et al (2014) Evaluation of the Sendai and 2012 international consensus guidelines based on cross-sectional imaging findings performed for the initial triage of mucinous cystic lesions of the pancreas: a single institution experience with 114 surgically treated patients. Am J Surg 208:202–209

    Article  Google Scholar 

  13. Nguyen AH, Toste PA, Farrell JJ et al (2015) Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer. J Gastrointest Surg 19:258–265

    Article  Google Scholar 

  14. Goh BK, Lin Z, Tan DM et al (2015) Evaluation of the Fukuoka consensus guidelines for intraductal papillary mucinous neoplasms of the pancreas: results from a systematic review of 1,382 surgically resected patients. Surgery 158:1192–1202

    Article  Google Scholar 

  15. Campbell NM, Katz SS, Escalon JG et al (2015) Imaging patterns of intraductal papillary mucinous neoplasms of the pancreas: an illustrated discussion of the international consensus guidelines for the management of IPMN. Abdom Imaging 40:663–677

    Article  Google Scholar 

  16. Ricci C, Casadei R, Taffurelli G et al (2016) Risk factors for malignancy of branch-duct intraductal papillary mucinous neoplasms: a critical evaluation of the Fukuoka guidelines with a systematic review and meta-analysis. Pancreas 45:1243–1254

    Article  Google Scholar 

  17. Seo N, Byun JH, Kim JH et al (2016) Validation of the 2012 international consensus guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 263:557–564

    Article  Google Scholar 

  18. Sighinolfi M, Quan SY, Lee Y et al (2017) Fukuoka and AGA criteria have superior diagnostic accuracy for advanced cystic neoplasms than Sendai criteria. Dig Dis Sci 62:626–632

    Article  Google Scholar 

  19. Han DH, Lee H, Park JY et al (2016) Validation of international consensus guideline 2012 for intraductal papillary mucinous neoplasm of pancreas. Ann Surg Treat Res 90:124–130

    Article  Google Scholar 

  20. Watanabe Y, Nishihara K, Niina Y et al (2016) Validity of the management strategy for intraductal papillary mucinous neoplasm advocated by the international consensus guidelines 2012: a retrospective review. Surg Today 46:1045–1052

    Article  Google Scholar 

  21. Anand N, Sampath K, Wu BU (2013) Cyst features and risk of malignancy in IPMNs of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol 11:913–921

    Article  Google Scholar 

  22. Kim KW, Park SH, Pyo J et al (2014) Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Ann Surg 259:72–81

    Article  Google Scholar 

  23. Weinberg BM, Spiegel BM, Tomlinson JS et al (2010) Asymptomatic pancreatic cystic neoplasms: maximizing survival and quality of life using Markov-based clinical nomograms. Gastroenterology 138:531–540

    Article  Google Scholar 

  24. Tamura K, Ohtsuka T, Ideno N et al (2013) Unresectable pancreatic ductal adenocarcinoma in the remnant pancreas diagnosed during every-6-month surveillance after resection of branch duct intraductal papillary mucinous neoplasm: a case report. JOP 14:450–453

    PubMed  Google Scholar 

  25. Berland LL, Silverman SG, Gore RM et al (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7:754–773

    Article  Google Scholar 

  26. Vege SS, Ziring B, Jain R, Clinical Guidelines Committee; American Gastroenterology Association et al (2015) American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:819–822

    Article  Google Scholar 

  27. Yamaguchi K, Nakamura K, Yokohata K et al (1997) Pancreatic cyst as a sentinel of in situ carcinoma of the pancreas. Report of two cases. Int J Pancreatol 22:227–231

    CAS  PubMed  Google Scholar 

  28. Tada M, Kawabe T, Arizumi M et al (2006) Pancreatic cancer in patients with pancreatic cystic lesions: a prospective study in 197 patients. Clin Gastroenterol Hepatol 4:1265–1270

    Article  Google Scholar 

  29. Uehara H, Nakaizumi A, Ishikawa O et al (2008) Development of ductal carcinoma of the pancreas during follow-up of branch duct intraductal papillary mucinous neoplasm of the pancreas. Gut 57:1561–1565

    Article  CAS  Google Scholar 

  30. Kuroki T, Tajima Y, Tsuneoka N et al (2008) Combined pancreatic resection and pancreatic duct-navigation surgery for multiple lesions of the pancreas: intraductal papillary mucinous neoplasm of the pancreas concomitant with ductal carcinoma of the pancreas. Hepato-Gastroenterology 55:1830–1833

    PubMed  Google Scholar 

  31. Sakamoto H, Kitano M, Komaki T et al (2009) Small invasive ductal carcinoma of the pancreas distinct from branch duct intraductal papillary mucinous neoplasm. World J Gastroenterol 15:5489–5492

    Article  Google Scholar 

  32. Ingkakul T, Sadakari Y, Ienaga J et al (2010) Predictors of the presence of concomitant invasive ductal carcinoma in intraductal papillary mucinous neoplasm of the pancreas. Ann Surg 251:70–75

    Article  Google Scholar 

  33. Tanno S, Nakano Y, Koizumi K et al (2010) Pancreatic ductal adenocarcinomas in long-term follow-up patients with branch duct intraductal papillary mucinous neoplasms. Pancreas 39:36–40

    Article  Google Scholar 

  34. Tanno S, Nakano Y, Sugiyama Y et al (2010) Incidence of synchronous and metachronous pancreatic carcinoma in 168 patients with branch duct intraductal papillary mucinous neoplasm. Pancreatology 10:173–178

    Article  Google Scholar 

  35. Jarry J, Belleannee G, Rault A et al (2010) Can an intraductal papillary mucinous tumor be a potential indicator of concurrent adenocarcinoma of the pancreas? JOP 11:55–57

    PubMed  Google Scholar 

  36. Mori Y, Ohtsuka T, Tsutsumi K et al (2010) Multifocal pancreatic ductal adenocarcinomas concomitant with intraductal papillary mucinous neoplasms of the pancreas detected by intraoperative pancreatic juice cytology. A case report. JOP 11:389–392

    PubMed  Google Scholar 

  37. Kanno A, Satoh K, Hirota M et al (2010) Prediction of invasive carcinoma in branch type intraductal papillary mucinous neoplasms of the pancreas. J Gastroenterol 45:952–959

    Article  Google Scholar 

  38. Yamaguchi K, Kanemitsu S, Hatori T et al (2011) Pancreatic ductal adenocarcinoma derived from IPMN and pancreatic ductal adenocarcinoma concomitant with IPMN. Pancreas 40:571–580

    Article  Google Scholar 

  39. Maguchi H, Tanno S, Mizuno N et al (2011) Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas 40:364–370

    Article  Google Scholar 

  40. Ohtsuka T, Kono H, Tanabe R et al (2012) Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas. Am J Surg 204:44–48

    Article  Google Scholar 

  41. Khannoussi W, Vullierme MP, Rebours V et al (2012) The long term risk of malignancy in patients with branch duct IPMNs of the pancreas. Pancreatology 12:198–202

    Article  Google Scholar 

  42. Ideno N, Ohtsuka T, Kono H et al (2013) Intraductal papillary mucinous neoplasms of the pancreas with distinct pancreatic ductal adenocarcinomas are frequently of gastric subtype. Ann Surg 258:141–151

    Article  Google Scholar 

  43. Sahora K, Mino-Kenudson M, Brugge W et al (2013) Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg 258:466–475

    Article  Google Scholar 

  44. Lafemina J, Katabi N, Klimstra D et al (2013) Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol 20:440–447

    Article  CAS  Google Scholar 

  45. He J, Cameron JL, Ahuja N et al (2013) Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg 216:657–665

    Article  Google Scholar 

  46. Ohtsuka T, Ideno N, Aso T et al (2013) Role of endoscopic retrograde pancreatography for early detection of pancreatic ductal adenocarcinoma concomitant with intraductal papillary mucinous neoplasm of the pancreas. J Hepatobiliary Pancreat Sci 20:356–361

    Article  Google Scholar 

  47. Mori Y, Ohtsuka T, Tamura K et al (2014) Intraoperative irrigation cytology of the remnant pancreas to detect remnant distinct pancreatic ductal adenocarcinoma in patients with intraductal papillary mucinous neoplasm undergoing partial pancreatectomy. Surgery 155:67–73

    Article  Google Scholar 

  48. Kamata K, Kitano M, Kudo M et al (2014) Value of EUS in early detection of pancreatic ductal adenocarcinomas in patients with intraductal papillary mucinous neoplasms. Endoscopy 46:22–29

    Article  Google Scholar 

  49. Tanaka M (2014) Thirty years of experience with intraductal papillary mucinous neoplasm of the pancreas: from discovery to international consensus. Digestion 90:265–272

    Article  Google Scholar 

  50. Law JK, Wolfgang CL, Weiss MJ et al (2014) Concomitant pancreatic adenocarcinoma in a patient with branch-duct intraductal papillary mucinous neoplasm. World J Gastroenterol 20:9200–9204

    PubMed  PubMed Central  Google Scholar 

  51. Takano S, Fukasawa M, Maekawa S et al (2014) Deep sequencing of cancer-related genes revealed GNAS mutations to be associated with intraductal papillary mucinous neoplasms and its main pancreatic duct dilation. PLoS One 9:e98718

    Article  Google Scholar 

  52. Kawada N, Uehara H, Nagata S et al (2015) Imaging morphological changes of intraductal papillary mucinous neoplasm of the pancreas was associated with its malignant transformation but not with development of pancreatic ductal adenocarcinoma. Pancreatology 15:654–660

    Article  CAS  Google Scholar 

  53. Ideno N, Ohtsuka T, Matsunaga T et al (2015) Clinical significance of GNAS mutation in intraductal papillary mucinous neoplasm of the pancreas with concomitant pancreatic ductal adenocarcinoma. Pancreas 44:311–320

    Article  CAS  Google Scholar 

  54. Tanaka M (2015) Current roles of endoscopy in the management of intraductal papillary mucinous neoplasm of the pancreas. Dig Endosc 27:450–457

    Article  Google Scholar 

  55. Miyasaka Y, Ohtsuka T, Tamura K et al (2016) Predictive factors for the metachronous development of high-risk lesions in the remnant pancreas after partial pancreatectomy for intraductal papillary mucinous neoplasm. Ann Surg 263:1180–1187

    Article  Google Scholar 

  56. Sohn TA, Yeo CJ, Cameron JL et al (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–797

    Article  Google Scholar 

  57. White R, D'Angelica M, Katabi N et al (2007) Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm. J Am Coll Surg 204:987–993

    Article  Google Scholar 

  58. Khalid A, Brugge W (2007) ACG practice guidelines for the diagnosis and management of neoplastic pancreatic cysts. Am J Gastroenterol 102:2339–2349

    Article  Google Scholar 

  59. Jang JY, Kim SW, Lee SE et al (2008) Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol 15:199–205

    Article  Google Scholar 

  60. Wong J, Weber J, Centeno BA et al (2013) High-grade dysplasia and adenocarcinoma are frequent in side-branch intraductal papillary mucinous neoplasm measuring less than 3 cm on endoscopic ultrasound. J Gastrointest Surg 17:78–84

    Article  Google Scholar 

  61. Shindo K, Ueda J, Aishima S et al (2013) Small-sized, flat-type invasive branch duct intraductal papillary mucinous neoplasm: a case report. Case Rep Gastroenterol 7:449–454

    Article  Google Scholar 

  62. Brook OR, Beddy P, Pahade J et al (2016) Delayed growth in incidental pancreatic cysts: are the current American College of Radiology recommendations for follow-up appropriate? Radiology 278:752–761

    Article  Google Scholar 

  63. Del Chiaro M, Verbeke C, Salvia R et al (2013) European study group on cystic Tumours of the pancreas. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 45:703–711

    Article  Google Scholar 

  64. Sahani DV, Kambadakone A, Macari M et al (2013) Diagnosis and management of cystic pancreatic lesions. AJR Am J Roentgenol 200:343–354

    Article  Google Scholar 

  65. Shi C, Hruban RH (2012) Intraductal papillary mucinous neoplasm. Hum Pathol 43:1–16

    Article  Google Scholar 

  66. Sultana A, Jackson R, Tim G et al (2015) What is the best way to identify malignant transformation within pancreatic IPMN: a systematic review and meta-analyses. Clin Transl Gastroenterol 6:e130

    Article  CAS  Google Scholar 

  67. Das A, Wells CD, Nguyen CC (2008) Incidental cystic neoplasms of pancreas: what is the optimal interval of imaging surveillance? Am J Gastroenterol 103:1657–1662

    Article  Google Scholar 

  68. Macari M, Lee T, Kim S et al (2009) Is gadolinium necessary for MRI follow-up evaluation of cystic lesions in the pancreas? Preliminary results. AJR Am J Roentgenol 192:159–164

    Article  Google Scholar 

  69. Levy P, Jouannaud V, O’Toole D et al (2006) Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol 4:460–468

    Article  Google Scholar 

  70. Chari ST, Yadav D, Smyrk TC et al (2002) Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 123:1500–1507

    Article  Google Scholar 

  71. D’Angelica M, Brennan MF, Suriawinata AA et al (2004) Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg 239:400–408

    Article  Google Scholar 

  72. Yokoyama Y, Nagino M, Oda K et al (2007) Clinicopathologic features of re-resected cases of intraductal papillary mucinous neoplasms (IPMNs). Surgery 142:136–142

    Article  Google Scholar 

  73. Mino-Kenudson M, Fernandez-del Castillo C, Baba Y et al (2011) Prognosis of invasive intraductal papillary mucinous neoplasm depends on histological and precursor epithelial subtypes. Gut 60:1712–1720

    Article  Google Scholar 

  74. Salvia R, Fernandez-del Castillo C, Bassi C et al (2004) Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 239:678–685

    Article  Google Scholar 

  75. Sahani DV, Lin DJ, Venkatesan AM et al (2009) Multidisciplinary approach to diagnosis and management of intraductal papillary mucinous neoplasms of the pancreas. Clin Gastroenterol Hepatol 7:259–269

    Article  Google Scholar 

  76. Buscarini E, Pezzilli R, Cannizzaro R, Cystic Pancreatic Neoplasm Study Group et al (2014) Italian consensus guidelines for the diagnostic work-up and follow-up of cystic pancreatic neoplasms. Dig Liver Dis 46:479–493

    Article  Google Scholar 

  77. Scheiman JM, Hwang JH, Moayyedi P (2015) American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 148:824–848

    Article  Google Scholar 

  78. Moris M, Raimondo M, Woodward TA et al (2017) International intraductal papillary mucinous neoplasms registry: long-term results based on the new guidelines. Pancreas 46:306–310

    Article  Google Scholar 

  79. Hirono S, Kawai M, Okada K et al (2016) Long-term surveillance is necessary after operative resection for intraductal papillary mucinous neoplasm of the pancreas. Surgery 160:306–317

    Article  Google Scholar 

  80. Yogi T, Hijioka S, Imaoka H et al (2015) Risk factors for postoperative recurrence of intraductal papillary mucinous neoplasms of the pancreas based on a long-term follow-up study: proposals for follow-up strategies. J Hepatobiliary Pancreat Sci 22:757–765

    Article  Google Scholar 

  81. Correa-Gallego C, Do R, Lafemina J et al (2013) Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Ann Surg Oncol 20:4348–4355

    Article  Google Scholar 

  82. Shimizu Y, Yamaue H, Maguchi H et al (2015) Validation of a nomogram for predicting the probability of carcinoma in patients with intraductal papillary mucinous neoplasm in 180 pancreatic resection patients at 3 high-volume centers. Pancreas 44:459–464

    PubMed  Google Scholar 

  83. Jang JY, Park T, Lee S et al (2016) Proposed nomogram predicting the individual risk of malignancy in the patients with branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 266(6):1062–1068 [Epub ahead of print]

    Article  Google Scholar 

  84. Attiyeh MA, Fernández-Del Castillo C, Al Efishat M et al (2016) Development and validation of a multi-institutional preoperative nomogram for predicting grade of dysplasia in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: a report from the pancreatic surgery consortium. Ann Surg 267(1):157–163 [Epub ahead of print]

    Article  Google Scholar 

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  1. Shimonoseki City Hospital, Kyushu University, Shimonoseki, Yamaguchi, Japan

    Masao Tanaka

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  1. Masao Tanaka
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Correspondence to Masao Tanaka .

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  1. Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA

    Gloria H. Su

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Tanaka, M. (2019). Clinical Management and Surgical Decision-Making of IPMN of the Pancreas. In: Su, G. (eds) Pancreatic Cancer. Methods in Molecular Biology, vol 1882. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-8879-2_2

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  • DOI: https://doi.org/10.1007/978-1-4939-8879-2_2

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