Outcomes of Primary Surveillance for Intraductal Papillary Mucinous Neoplasm
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Limited data are available regarding the natural history of patients undergoing primary surveillance for intraductal papillary mucinous neoplasm (IPMN). We hypothesize that symptoms, radiologic characteristics, and cytopathology will predict cancer risk during surveillance.
Between March 2002 and March 2010, 522 patients were diagnosed with IPMN at a single, high-volume institution. Low versus high oncologic risk was stratified prospectively. Patients with under 3 months of surveillance were excluded.
Two hundred ninety-two patients underwent primary surveillance for IPMN. Two hundred forty-four (84%) were classified as low-risk IPMN. Mean surveillance duration was 35 (4–99) months. Thirty (12%) patients initially stratified as low-risk developed a new indication for pancreatic resection. Only 28 underwent resection, and pathologic tissue analysis revealed 27 (96%) low-grade IPMN and one (4%) high-grade dysplastic IPMN. Overall, two (1%) patients initially determined to be low-risk developed invasive cancer. Forty-eight (16%) patients stratified as high-risk IPMN were initially managed nonoperatively. Of the 13 (27%) high-risk patients that died during follow-up, two (15%) died from pancreatic cancer.
Progression to pancreatic cancer during surveillance for low-risk IPMN was rare. Current indications for resection did not forecast malignancy. Poor operative candidates with high-risk IPMN progressed to invasive cancer more commonly, though a substantial portion succumbed to non-IPMN-related death.
- Sohn TA, Y.C., Cameron JL, Iacobuzio-Donahue CA, Hruban RH, Lillemoe KD., Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg, 2001. 234(3): p. 313–21
- Tanaka, M., et al., International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology, 2006. 6(1–2): p. 17–32. CrossRef
- Gourgiotis, S., M.P. Ridolfini, and S. Germanos, Intraductal papillary mucinous neoplasms of the pancreas. European Journal of Surgical Oncology (EJSO), 2007. 33(6): p. 678–684. CrossRef
- Hruban, R.H.M.T., Kyoichi MD, PhD; Klimstra, David S MD; Adsay, N Volkan MD; Albores-Saavedra, Jorge MD; Biankin, Andrew V MBBS, PhD; Biankin, Sandra A MBBS; Compton, Carolyn MD, PhD; Fukushima, Noriyoshi MD, PhD; Furukawa, Toru MD, PhD; Goggins, Michael MD; Kato, Yo MD, PhD; Kloppel, Gunter MD; Longnecker, Daniel S MD; Luttges, Jutta MD; Maitra, Anirban MBBS; Offerhaus, G Johan A MD; Shimizu, Michio MD, PhD; Yonezawa, Suguru MD, PhD, An Illustrated Consensus on the Classification of Pancreatic Intraepithelial Neoplasia and Intraductal Papillary Mucinous Neoplasms. The American Journal of Surgical Pathology, 2004. 28(8): p. 977–987.
- Longnecker DS, A.G., Hruban RH, Kloppel G, Intraductal papillary-mucinous neoplasms of the pancreas, in World Health Organization Classification of Tumors. Pathology and Genetics of Tumors of the Digestive System:, A.L. Hamilton SR, Editor. 2000, Lyon, IARC Press. p. 237–241
- Sho, M., et al., Pattern of Recurrence after Resection for Intraductal Papillary Mucinous Tumors of the Pancreas. World Journal of Surgery, 1998. 22(8): p. 874–878. CrossRef
- Sawai, Y., Yamao K, Bhatia V, Chiba T, N. Mizuno, A. Sawaki, K. Takahashi, M. Tajika, Y. Shimizu, Y. Yatabe, A. Yanagisawa, Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms. Endoscopy, 2010. 42(12): p. 1077–1084.
- D'Angelica M, B.M., Suriawinata AA, Klimstra D, Conlon KC., Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg, 2004. 239(3): p. 400–8.
- Spinelli KS, F.T., Daniel RA, Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA., Cystic pancreatic neoplasms: observe or operate. Ann Surg, 2004. 239(5): p. 651–7.
- Pelaez-Luna, M., et al., Do Consensus Indications for Resection in Branch Duct Intraductal Papillary Mucinous Neoplasm Predict Malignancy[quest] A Study of 147 Patients. Am J Gastroenterol, 2007. 102(8): p. 1759–1764. CrossRef
- Raut, C., et al., Intraductal Papillary Mucinous Neoplasms of the Pancreas: Effect of Invasion and Pancreatic Margin Status on Recurrence and Survival. Annals of Surgical Oncology, 2006. 13(4): p. 582–594. CrossRef
- Farnell, M.B., Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Journal of Gastrointestinal Surgery, 2008. 12(3): p. 414–6. CrossRef
- Wiesenauer, C.A., et al., Preoperative Predictors of Malignancy in Pancreatic Intraductal Papillary Mucinous Neoplasms. Arch Surg, 2003. 138(6): p. 610–618. CrossRef
- Schmidt CM, W.P., Waters JA, Yiannoutsos CT, Cummings OW, Baker M, Howard TJ, Zyromski NJ, Nakeeb A, DeWitt JM, Akisik FM, Sherman S, Pitt HA, Lillemoe KD., Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg, 2007. 246(4): p. 644–51.
- Waters, J., et al., CT vs MRCP: Optimal Classification of IPMN Type and Extent. Journal of Gastrointestinal Surgery, 2008. 12(1): p. 101–109. CrossRef
- Salvia R, F.-d.C.C., Bassi C, Thayer SP, Falconi M, Mantovani W, Pederzoli P, Warshaw AL, Main duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and longterm survival following resection. . Ann Surg, 2004. 239: p. 678–687
- Waters, J.A. and C.M. Schmidt, Intraductal Papillary Mucinous Neoplasm--When to Resect? Advances in Surgery, 2008. 42: p. 87–108. CrossRef
- Bassi, C., et al., Natural History of Intraductal Papillary Mucinous Neoplasms (IPMN): Current Evidence and Implications for Management. Journal of Gastrointestinal Surgery, 2008. 12(4): p. 645–650. CrossRef
- Rodriguez, J.R., et al., Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection. Gastroenterology, 2007. 133(1): p. 72–79. CrossRef
- Salvia, R., et al., Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut, 2007. 56(8): p. 1086–1090. CrossRef
- Sarr, M.G., et al., Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importance-current state-of-the-art and unanswered questions. Journal of Gastrointestinal Surgery, 2003. 7(3): p. 417–28. CrossRef
- Schmidt, C.M. and K.D. Lillemoe, IPMN—Controversies in an “Epidemic”. Journal of Surgical Oncology, 2006. 94(2): p. 91–93. CrossRef
- Sohn, T.A., et al., Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Annals of Surgery, 2004. 239(6): p. 788–97; discussion 797–9 CrossRef
- Bernard, P., et al., Intraductal Papillary-Mucinous Tumors of the Pancreas: Predictive Criteria of Malignancy According to Pathological Examination of 53 Cases. Arch Surg, 2002. 137(11): p. 1274–1278. CrossRef
- Sugiyama, M. and Y. Atomi, Extrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol, 1999. 94(2): p. 470–473. CrossRef
- White, R., et al., Fate of the Remnant Pancreas after Resection of Noninvasive Intraductal Papillary Mucinous Neoplasm. Journal of the American College of Surgeons, 2007. 204(5): p. 987–993. CrossRef
- Maker, A., et al., Pancreatic Cyst Fluid and Serum Mucin Levels Predict Dysplasia in Intraductal Papillary Mucinous Neoplasms of the Pancreas. Annals of Surgical Oncology, 2011. 18(1): p. 199–206. CrossRef
- Outcomes of Primary Surveillance for Intraductal Papillary Mucinous Neoplasm
Journal of Gastrointestinal Surgery
Volume 16, Issue 2 , pp 258-266
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Pancreatic cyst
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- 3. Department of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN, USA
- 5. Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- 2. Indiana University School of Medicine, Indianapolis, IN, USA
- 4. Biochemistry and Molecular Biology, Indiana University School of Medicine, 980 W Walnut St C522, Indianapolis, IN, 46202, USA