Skip to main content

Advertisement

SpringerLink
Log in

What is the Incidence of Malignancy in Resected Intraductal Papillary Mucinous Neoplasms? An Analysis of Over 100 US Institutions in a Single Year

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

Abstract

Background

A subset of intraductal papillary mucinous neoplasms (IPMNs) will progress to invasive adenocarcinoma, however identifying invasive from non-invasive disease preoperatively remains challenging. The rate of malignancy in resected IPMNs in the US remains unclear.

Objective

We aimed to determine the rate of malignancy and factors associated with high-risk pathology in resected IPMNs.

Methods

The most recent annual cohort of patients undergoing pancreatectomy included in the American College of Surgeons National Surgical Quality Improvement Program were assessed, and contributions of demographics, preoperative laboratory values, and outcome data to level of IPMN dysplasia were analyzed. The main outcomes were incidence of invasive carcinoma or high-grade dysplasia.

Results

Of 5025 pancreatectomies in 1 year, 478 patients underwent pancreatectomy for IPMN. Invasive carcinoma/high-grade dysplasia was identified in 23% of resected lesions, and there was no difference in patient characteristics or type of resection performed in patients with invasive versus non-invasive pathology. Patients with invasive IPMNs presented significantly more often with high liver function tests, >10% weight loss, clinical jaundice and stent placement, and were more likely to undergo an open operation (p = 0.03). There were no differences in perioperative outcomes. Adjusted logistic regression identified an association between invasive disease and non-soft pancreatic gland texture (odds ratio 0.19, 95% confidence interval 0.05–0.68, p < 0.01).

Conclusions

Approximately 10% of all pancreatectomies in the US are for IPMNs. In these patients, treated after the revised international consensus guidelines, only 23% of IPMNs contained invasive or high-grade histology. Resections carried similar morbidity regardless of pathology. Improved biomarkers are needed to aid in surgical selection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fernández-del Castillo C, Targarona J, Thayer SP, et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003;138(4):427–34; discussion 433–4.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Moris M, Bridges MD, Pooley RA, et al. Association between advances in high-resolution cross-section imaging technologies and increase in prevalence of pancreatic cysts from 2005 to 2014. Clin Gastroenterol Hepatol. 2016;14(4):585–93.

    Article  PubMed  Google Scholar 

  3. Schnelldorfer T, Sarr MG, Nagorney DM, et al. Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Arch Surg. 2008;143(7):639–46; discussion 646.

    Article  PubMed  Google Scholar 

  4. Farnell MB. Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. J Gastrointest Surg. 2008;12(3):414–6.

    Article  PubMed  Google Scholar 

  5. Maker AV, Lee LS, Raut CP, et al. Cytology from pancreatic cysts has marginal utility in surgical decision-making. Ann Surg Oncol. 2008;15(11):3187–92.

    Article  PubMed  Google Scholar 

  6. Suzuki Y, Nakazato T, Yokoyama M, et al. Development and potential utility of a new scoring formula for prediction of malignant intraductal papillary mucinous neoplasm of the pancreas. Pancreas. 2016;45(9):1227–32.

    Article  CAS  PubMed  Google Scholar 

  7. Shin SH, Han DJ, Park KT, et al. Validating a simple scoring system to predict malignancy and invasiveness of intraductal papillary mucinous neoplasms of the pancreas. World J Surg. 2010;34(4):776–83.

    Article  PubMed  Google Scholar 

  8. Fujino Y, Matsumoto I, Ueda T, et al. Proposed new score predicting malignancy of intraductal papillary mucinous neoplasms of the pancreas. Am J Surg. 2007;194(3):304–7.

    Article  PubMed  Google Scholar 

  9. Wilson GC, Maithel SK, Bentrem D, et al. Are the current guidelines for the surgical management of intraductal papillary mucinous neoplasms of the pancreas adequate? A multi-institutional study. J Am Coll Surg. 2017;224(4):461–9.

    Article  PubMed  Google Scholar 

  10. 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(3):466–75.

    Article  PubMed  Google Scholar 

  11. Fritz S, Klauss M, Bergmann F, et al. Pancreatic main-duct involvement in branch-duct IPMNs: an underestimated risk. Ann Surg. 2014;260(5):848–55; discussion 855–6.

    Article  PubMed  Google Scholar 

  12. Reid-Lombardo KM, St Sauver J, Li Z, et al. Incidence, prevalence, and management of intraductal papillary mucinous neoplasm in Olmsted County, Minnesota, 1984–2005: a population study. Pancreas. 2008;37(2):139–44.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fernández-del Castillo C, Warshaw AL. Cystic tumors of the pancreas. Surg Clin N Am. 1995;75(5):1001–16.

    Article  PubMed  Google Scholar 

  14. 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. Pancreatology. 2006;6(1–2):17–32.

    Article  PubMed  Google Scholar 

  15. Tanaka M, Fernández-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12(3):183–97.

    Article  PubMed  Google Scholar 

  16. Fink AS, Campbell DA Jr, Mentzer RM Jr, et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg. 2002;236(3):344–53; discussion 353-4.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shimizu Y, Yamaue H, Maguchi H, et al. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas. 2013;42(5):883–8.

    Article  CAS  PubMed  Google Scholar 

  18. Hackert T, Fritz S, Klauss M, et al. Main-duct intraductal papillary mucinous neoplasm: high cancer risk in duct diameter of 5 to 9 mm. Ann Surg. 2015;262(5):875–80; discussion 880–1.

    Article  PubMed  Google Scholar 

  19. Fan F, Lai EC, Xie F, Yang JM, et al. Intraductal papillary mucinous neoplasms of the pancreas–predictors of malignancy. Hepatogastroenterology. 2010;57(99–100):635–9.

    PubMed  Google Scholar 

  20. Jang JY, Kim SW, Ahn YJ, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol. 2005;12(2):124–32.

    Article  PubMed  Google Scholar 

  21. Kim JR, Jang JY, Kang MJ, et al. Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19-9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas. J Hepatobiliary Pancreat Sci. 2015;22(9):699–707.

    Article  PubMed  Google Scholar 

  22. Maire F, Voitot H, Aubert A, et al. Intraductal papillary mucinous neoplasms of the pancreas: performance of pancreatic fluid analysis for positive diagnosis and the prediction of malignancy. Am J Gastroenterol. 2008;103(11):2871–7.

    Article  PubMed  Google Scholar 

  23. Honselmann KC, Patino M, Mino-Kenudson M, et al. Ductal carcinoma arising in a largely unchanged presumed branch-duct IPMN after 10 years of surveillance. Ann Surg. 2017;266(6):e38–40.

    Article  PubMed  Google Scholar 

  24. Maker AV, Katabi N, Gonen M, et al. Pancreatic cyst fluid and serum mucin levels predict dysplasia in intraductal papillary mucinous neoplasms of the pancreas. Ann Surg Oncol. 2011;18(1):199–206.

    Article  PubMed  Google Scholar 

  25. Maker AV, Katabi N, Qin LX, et al. Cyst fluid interleukin-1beta (IL1beta) levels predict the risk of carcinoma in intraductal papillary mucinous neoplasms of the pancreas. Clin Cancer Res. 2011;17(6):1502–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Maker AV, Carrara S, Jamieson NB, et al. Cyst fluid biomarkers for intraductal papillary mucinous neoplasms of the pancreas: a critical review from the international expert meeting of pancreatic branch-duct-intraductal papillary mucinous neoplasms. J Am Coll Surg. 2015;220(2):243–53.

    Article  PubMed  Google Scholar 

  27. Tulla KA, Maker AV. Can we better predict the biologic behavior of incidental IPMN? A comprehensive analysis of molecular diagnostics and biomarkers in intraductal papillary mucinous neoplasms of the pancreas. Langenbecks Arch Surg. 2017. https://doi.org/10.1007/s00423-017-1644-z.

    PubMed  Google Scholar 

Download references

Conflicts of interest

Dr. Ajay Maker is supported by an NIH/NCI Grant (K08CA190855). Rym El Khoury, Christopher Kabir, Vijay K. Maker, Mihaela Banulescu, and Margaret Wasserman report no conflicts of interest.

Disclosures

The ACS NSQIP and the hospitals participating in the ACS NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, 835 S. Wolcott St. MC790, Chicago, IL, 60612, USA

    Rym El Khoury MD, Vijay K. Maker MD & Ajay V. Maker MD

  2. Department of Surgery, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA

    Rym El Khoury MD, Vijay K. Maker MD, Mihaela Banulescu MSRC, Margaret Wasserman BSN, RN & Ajay V. Maker MD

  3. Advocate Research Institute, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA

    Christopher Kabir MS

Authors
  1. Rym El Khoury MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher Kabir MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vijay K. Maker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mihaela Banulescu MSRC
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Margaret Wasserman BSN, RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ajay V. Maker MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ajay V. Maker MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khoury, R.E., Kabir, C., Maker, V.K. et al. What is the Incidence of Malignancy in Resected Intraductal Papillary Mucinous Neoplasms? An Analysis of Over 100 US Institutions in a Single Year. Ann Surg Oncol 25, 1746–1751 (2018). https://doi.org/10.1245/s10434-018-6425-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-6425-6

Keywords

Search

Navigation