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Fukuoka-Negative Branch-Duct IPMNs: When to Worry? A Study from the French Surgical Association (AFC)

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study analyzed the pathologic findings for patients with Fukuoka-negative branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) who theoretically were eligible for surveillance care with follow-up assessment, but instead underwent resection.

Methods

From January 2005 to December 2012, 820 patients underwent evaluation for IPMN. At initial staging, 319 patients had BD-IPMN, and 89 of these patients presented with Fukuoka-negative criteria. These 89 patients were included in this study.

Results

Of the 89 patients, 55 (62%) underwent pancreatectomy. After pathologic examination, the ultimate diagnosis was MT-IPMN for 20 (36%) of these patients (the MT group) and BD-IPMN for 35 (64%) of these patients (the BD group). The remaining 34 patients (38%) underwent enucleation. The patients in the MT group were more likely to be male (P = 0.01) and to have a higher rate of recent (< 1 year) diabetes mellitus diagnosis (P = 0.007) than the patients in the BD group. In the multivariate analysis, diabetes mellitus was independently associated with involvement of the main pancreatic duct (P = 0.05). Malignancy was diagnosed for 14 (16%) of the 89 patients. The rate of invasive IPMN was higher in the MT group than in the BD group (20% vs. 0%, P = 0.02). The 5-year overall survival rate was 100% for the BD group and 84% for the MT group (P = 0.02). For the male patients with diabetes mellitus, the rate of malignancy rose to 67%.

Conclusions

For patients with a diagnosis of Fukuoka-negative BD-IPMN, resection should be considered primarily for male patients with a recent diabetes mellitus diagnosis.

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References

  1. Kloeppel G, Solcia E, Longnecker DS, et al. Histological typing of tumours of the exocrine pancreas. In: Kloeppel G, editor. World Health Organization International Histological Classification of Tumours. 2nd ed. Berlin: Springer; 1996. P. 1–60.

    Google Scholar 

  2. Adsay V, Mino-Kenudson M, Furukawa T, et al. Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract. Ann Surg. 2016;263:162–77.

    Article  PubMed  PubMed Central  Google Scholar 

  3. D’Angelica M, Brennan MF, Suriawinata AA, Klimstra D, Conlon KC. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004;239:400–8.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. International Association of Pancreatology. Pancreatology. 2012;12:183–97.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  6. Sahora K, Mino-Kenudson M, Brugge W, et al. 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. 2013;258:466–75.

    Article  PubMed  Google Scholar 

  7. Goh BK, Tan DM, Ho MM, Lim TK, Chung AY, Ooi LL. Utility of the Sendai consensus guidelines for branch-duct intraductal papillary mucinous neoplasms: a systematic review. J Gastrointest Surg. 2014;18:1350–7.

    Article  PubMed  Google Scholar 

  8. Han DH, Lee H, Park JY, Kwon W, Heo JS, Choi SH, Choi DW. Validation of international consensus guideline 2012 for intraductal papillary mucinous neoplasm of pancreas. Ann Surg Treat Res. 2016;90:124–30.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Heckler M, Michalski CW, Schaefle S, Kaiser J, Büchler MW, Hackert T. The Sendai and Fukuoka consensus criteria for the management of branch duct IPMN: a meta-analysis on their accuracy. Pancreatology. 2017;17:255–62.

    Article  PubMed  Google Scholar 

  10. Fritz S, Klauss M, Bergmann F, et al. Pancreatic main duct involvement in branch-duct IPMNs: an underestimated risk. Ann Surg. 2014;260:848–55.

    Article  PubMed  Google Scholar 

  11. Kaiser J, Fritz S, Klauss M, et al. Enucleation: a treatment alternative for branch duct intraductal papillary mucinous neoplasms. Surgery. 2017;161:602–10.

    Article  PubMed  Google Scholar 

  12. Hwang DW, Jang JY, Lee SE, et al. Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution. Langenbecks Arch Surg. 2012;397:93–102.

    Article  PubMed  Google Scholar 

  13. Masuda A, Arisaka Y, Hara S, et al. MUC2 expression and prevalence of high-grade dysplasia and invasive carcinoma in MT-intraductal papillary mucinous neoplasm of the pancreas. Pancreatology. 2013;13:583–8.

    Article  CAS  PubMed  Google Scholar 

  14. Sahora K, Fernandez-del Castillo C, Dong F, et al. Not all MT-intraductal papillary mucinous neoplasms behave like main-duct lesions: implications of minimal involvement of the main pancreatic duct. Surgery. 2014;156:611–21.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Roch AM, Schmidt CM. Management of mixed-type intraductal papillary mucinous neoplasm. Adv Surg. 2016;50:1–15.

    Article  PubMed  Google Scholar 

  16. Ceppa EP, Roch AM, Cioffi JL, et al. Invasive, mixed-type intraductal papillary mucinous neoplasm: superior prognosis compared to invasive main-duct intraductal papillary mucinous neoplasm. Surgery. 2015;158:937–44.

    Article  PubMed  Google Scholar 

  17. Crippa S, Bassi C, Salvia R, et al. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing nonoperative management: a mid-term follow-up analysis. Gut. 2016.

  18. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471–4. https://doi.org/10.1245/s10434-010-0985-4.

    Article  PubMed  Google Scholar 

  19. Chang DK, Johns AL, Merrett ND, et al. Margin clearance and outcome in resected pancreatic cancer. J Clin Oncol. 2009;27:2855–62.

    Article  PubMed  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    Article  PubMed  Google Scholar 

  22. Barron MR, Roch AM, Waters JA, et al. Does preoperative imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm? J Gastrointest Surg. 2014;18:447–56.

    Article  CAS  PubMed  Google Scholar 

  23. Nimptsch U, Krautz C, Weber GF, Mansky T, Grützmann R. Nationwide in-hospital mortality following pancreatic surgery in Germany is higher than anticipated. Ann Surg. 2016;264:1082–90.

    Article  PubMed  Google Scholar 

  24. Sturm EC, Roch AM, Shaffer KM, et al. Obesity increases malignant risk in patients with branch-duct intraductal papillary mucinous neoplasm. Surgery. 2013;154:803–8.

    Article  PubMed  Google Scholar 

  25. Fritz S, Schirren M, Klauss M, et al. Clinicopathologic characteristics of patients with resected multifocal intraductal papillary mucinous neoplasm of the pancreas. Surgery. 2012;152:S74–80.

    Article  PubMed  Google Scholar 

  26. Kang MJ, Jang JY, Kim SJ, et al. Cyst growth rate predicts malignancy in patients with branch duct intraductal papillary mucinous neoplasms. Clin Gastroenterol Hepatol. 2011;9:87–93.

    Article  PubMed  Google Scholar 

  27. Bournet B, Vignolle-Vidoni A, Grand D, et al. Endoscopic ultrasound-guided fine-needle aspiration plus KRAS and GNAS mutation in malignant intraductal papillary mucinous neoplasm of the pancreas. Endosc Int Open. 2016;4:E1228–35.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Crippa S, Capurso G, Cammà C, Delle Fave G, Castillo CF, Falconi M. Risk of pancreatic malignancy and mortality in branch-duct IPMNs undergoing surveillance: a systematic review and meta-analysis. Dig Liver Dis. 2016;48:473–9.

    Article  PubMed  Google Scholar 

  29. Khannoussi W, Vullierme MP, Rebours V, et al. The long-term risk of malignancy in patients with branch-duct intraductal papillary mucinous neoplasms of the pancreas. Pancreatology. 2012;12:198–202.

    Article  PubMed  Google Scholar 

  30. Turrini O, Schmidt CM, Pitt HA, et al. Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? HPB Oxford. 2011;13:126–31.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Blanc B, Sauvanet A, Couvelard A, et al. Limited pancreatic resections for intraductal papillary mucinous neoplasm. J Chir Paris. 2008;145:568–78.

    Article  CAS  PubMed  Google Scholar 

  32. D’Angelica M, Brennan MF, Suriawinata AA, Klimstra D, Conlon KC. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004;239:400–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Correa-Gallego C, Do R, Lafemina J, et al. Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Ann Surg Oncol. 2013;20:4348–55.

    Article  PubMed  Google Scholar 

  34. Leal JN, Kingham TP, D’Angelica MI, DeMatteo RP, Jarnagin WR, Kalin MF, Allen PJ. Intraductal papillary mucinous neoplasms and the risk of diabetes mellitus in patients undergoing resection versus observation. J Gastrointest Surg. 2015;19:1974–81.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgment

We thank all the following people who contributed to this study: Dr. Addeo (Strasbourg), Dr. Alyani (Lille), Pr. Bail (Brest), Dr. Barbe (Brest), Pr. Berdah (Marseille), Dr. Birnbaum (Marseille), Dr. Blehaut (Lyon), Boher (Marseille), Pr. Brunet (Marseille), Dr. Buscaïl (Bordeaux), Dr. Cahais (Rouen), Delaunay (Lyon), Dr. Delhorme (Strasbourg), Pr. Delpero (Marseille), Pr. Ducerf (Lyon), Dr. Elamrani (Lille), Dr. Ewald (Marseille), Pr. Fabre (Montpellier), Dr. Faitot (Strasbourg), Dr. Fusco (Paris), Dr. Giordano (Eaubonne), Pr. Hannoun (Paris), Dr. Hor (Paris), Dr. Housseau (Strasbourg), Dr. Jeune (Paris), Dr. Jeddou (Strasbourg), Laborde (Marseille), Dr. Laurenzi (Paris), Pr. Letoublon (Grenoble), Dr. Leynaud (Montluçon), Dr. Maarouf (Lyon), Pr. Marescaux (Strasbourg), Dr. Maignan (Marseille), Martin (Marseille), Dr. Méméo (Strasbourg), Dr. Mezoughi (Lyon), Dr. Monsch (Starsbourg), Pr. Moutardier (Marseille), Dr. Mutter (Strasbourg), Dr. Nappo (Lyon), Dr. Orsoni (Marseille), Pr Paye (Paris), Pr. Piessen (Lille), Dr. Pittau (Paris), Dr. Poiblanc (Lyon), Dr. Risse (Grenoble), Dr. Regenet (Nantes), Dr. Senellart (Nantes), Dr. Ouaissi (Marseille), Pr. Pessaux (Strasbourg), Pr. Pruvot (Lille), Pr. Sa Cuhna (Paris), Pr. Sastre (Marseille), Pr. Sauvanet (Paris), Dr. Schwarz (Rouen), Pr. Sielezneff (Marseille), Dr. Souche (Montpellier), and Dr. Truant (Lille), Pr. Vaillant (Paris). We thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Surgery, Hôpital Nord, Marseille, France

    Pauline Duconseil MD

  2. Department of Surgery, Hôpital Edouard-Herriot, Lyon, France

    Mustapha Adham MD & Julie Périnel MD

  3. Department of Surgery, Hôpital Beaujon, Paris, France

    Alain Sauvanet MD, PhD

  4. Department of Biostatistics, Institut Paoli-Calmettes, Marseille, France

    Aurélie Autret MSc

  5. Department of Surgery, Maison du Haut-Lévêque, Bordeaux, France

    Laurence Chiche MD, PhD

  6. Department of Surgery, Hôpital de la Croix Rousse, Lyon, France

    Jean-Yves Mabrut MD, PhD

  7. Department of Surgery, Hôpital Charles Nicolle, Rouen, France

    Jean-Jacques Tuech MD, PhD

  8. Department of Surgery, Hôpital Claude-Huriez, Lille, France

    Christophe Mariette MD, PhD

  9. Department of Surgery, Institut Paoli-Calmettes, Marseille, France

    Olivier Turrini MD, PhD

  10. Department of Digestive Surgery, Hôpital Nord, Marseille, France

    Pauline Duconseil MD

Authors
  1. Pauline Duconseil MD
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  2. Mustapha Adham MD
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  3. Alain Sauvanet MD, PhD
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  4. Aurélie Autret MSc
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  6. Laurence Chiche MD, PhD
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  7. Jean-Yves Mabrut MD, PhD
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  9. Christophe Mariette MD, PhD
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  10. Olivier Turrini MD, PhD
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Corresponding author

Correspondence to Pauline Duconseil MD.

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Duconseil, P., Adham, M., Sauvanet, A. et al. Fukuoka-Negative Branch-Duct IPMNs: When to Worry? A Study from the French Surgical Association (AFC). Ann Surg Oncol 25, 1017–1025 (2018). https://doi.org/10.1245/s10434-017-6318-0

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  • DOI: https://doi.org/10.1245/s10434-017-6318-0

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