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Predictors of early stages of histological progression of branch duct IPMN

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Abstract

Background

An appropriate timing for surgical resection of branch duct-type intraductal papillary mucinous neoplasm (BD-IPMN) to achieve sufficient postoperative survival is still unknown.

Methods

Of 80 patients with histologically proven IPMNs, 61 patients who had BD-IPMN without pancreatic cancer concomitant with IPMN were enrolled in this study. We divided BD-IPMN into four groups according to disease progression: low to intermediate grade of dysplasia (LGD/IGD-IPMN), high grade of dysplasia (HGD-IPMN), minimally invasive IPMN (MI-IPMN: T1a), and invasive IPMN (IN-IPMN: ≥T1b). Indicators of surgical resection were investigated on the basis of pathological findings and postoperative prognosis.

Results

Postoperative survival was distinctly worse for patients with IN-IPMN than for patients with MI-IPMN, HGD-IPMN, and LGD/IGD-IPMN. Postoperative disease-specific 5-year survival rate was 100 % in patients with IN-IPMN, HGD-IPMN, and LGD/IGD-IPMN, by contrast, 40 % in patients with IN-IPMN. The presence of two of the three factors (pancreatitis, serum carbohydrate antigen [CA] 19-9 levels >13 U/mL, and mural nodules) could distinguish HGD-IPMN from LGD/IGD-IPMN with a sensitivity of 92.9 %, specificity of 90.2 %, positive predictive value of 76.5 %, negative predictive value of 97.4 %, and accuracy of 90.9 %.

Conclusions

To manage patients with BD-IPMN and achieve a good postoperative prognosis, surgical resection should be performed before progression to IN-IPMN.

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Conflicts of interest

The authors state that they have no conflicts of interest and that they received no financial or material support.

Authors’ contributions

Hiroshi Kurahara: study conception and design and drafting of manuscript. Kosei Maemura, Yuko Mataki, and Yuko Kijima: acquisition of data. Masahiko Sakoda, Satoshi Iino, and Shinichi Ueno: analysis and interpretation of data. Sumiya Ishigami, Hiroyuki Shinchi, and Shoji Natsugoe: critical revision of manuscript.

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Authors and Affiliations

  1. Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Hiroshi Kurahara, Kosei Maemura, Yuko Mataki, Masahiko Sakoda, Satoshi Iino, Yuko Kijima, Sumiya Ishigami & Shoji Natsugoe

  2. Department of Clinical Oncology, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Shinichi Ueno

  3. Department of Health Sciences, Graduate School of Medical Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan

    Hiroyuki Shinchi

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  1. Hiroshi Kurahara
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Correspondence to Hiroshi Kurahara.

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Kurahara, H., Maemura, K., Mataki, Y. et al. Predictors of early stages of histological progression of branch duct IPMN. Langenbecks Arch Surg 400, 49–56 (2015). https://doi.org/10.1007/s00423-014-1259-6

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  • DOI: https://doi.org/10.1007/s00423-014-1259-6

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