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The Dilemma of the Dilated Main Pancreatic Duct in the Distal Pancreatic Remnant After Proximal Pancreatectomy for IPMN

  • Rachel E. Simpson
  • Eugene P. Ceppa
  • Howard H. Wu
  • Fatih Akisik
  • Michael G. House
  • Nicholas J. Zyromski
  • Attila Nakeeb
  • Mohammad A. Al-Haddad
  • John M. DeWitt
  • Stuart Sherman
  • C. Max SchmidtEmail author
Original Article 2018 SSAT Plenary Presentation
  • 52 Downloads

Abstract

Objective(s)

A dilated main pancreatic duct in the distal remnant after proximal pancreatectomy for intraductal papillary mucinous neoplasms (IPMN) poses a diagnostic dilemma. We sought to determine parameters predictive of remnant main-duct IPMN and malignancy during surveillance.

Methods

Three hundred seventeen patients underwent proximal pancreatectomy for IPMN (Indiana University, 1991–2016). Main-duct dilation included those ≥ 5 mm or “dilated” on radiographic reports. Statistics compared groups using Student’s T/Mann-Whitney U tests for continuous variables or chi-square/Fisher’s exact test for categorical variables with P < 0.05 considered significant.

Results

High-grade/invasive IPMN or adenocarcinoma at proximal pancreatectomy predicted malignant outcomes (100.0% malignant outcomes; P < 0.001) in remnant surveillance. Low/moderate-grade lesions revealed benign outcomes at last surveillance regardless of duct diameter. Twenty of 21 patients undergoing distal remnant reoperation had a dilated main duct. Seven had main-duct IPMN on remnant pathology; these patients had greater mean maximum main-duct diameter prior to reoperation (9.5 vs 6.2 mm, P = 0.072), but this did not reach statistical significance. Several features showed high sensitivity/specificity for remnant main-duct IPMN.

Conclusions

Remnant main-duct dilation after proximal pancreatectomy for IPMN remains a diagnostic dilemma. Several parameters show a promise in accurately diagnosing main-duct IPMN in the remnant.

Keywords

Pancreatic duct Pancreatic neoplasms Mucinous neoplasms Pancreatic cyst Pancreaticoduodenectomy 

Notes

Author Contributions

Drs. Schmidt and Simpson: conception/design of the work; data acquisition, analysis, and interpretation; manuscript drafting/revision/final approval; agreement to accountability.

Drs. Ceppa, Wu, Akisik, House, Zyromski, Nakeeb, Al-Haddad, DeWitt, and Sherman: data acquisition/interpretation; manuscript revision/final approval; agreement to accountability.

Compliance with Ethical Standards

Conflict of Interest

No true conflict of interest relevant to this work. Consultants for Boston Scientific (Dr. Al-Haddad and Dr. Sherman).

Supplementary material

11605_2018_4026_MOESM1_ESM.docx (22 kb)
Supplemental Table 1 (DOCX 21 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Rachel E. Simpson
    • 1
  • Eugene P. Ceppa
    • 1
    • 2
  • Howard H. Wu
    • 3
  • Fatih Akisik
    • 4
  • Michael G. House
    • 1
  • Nicholas J. Zyromski
    • 1
  • Attila Nakeeb
    • 1
  • Mohammad A. Al-Haddad
    • 2
    • 5
  • John M. DeWitt
    • 5
  • Stuart Sherman
    • 5
  • C. Max Schmidt
    • 1
    • 2
    • 6
    • 7
    • 8
    Email author
  1. 1.Department of SurgeryIndiana University School of MedicineIndianapolisUSA
  2. 2.Indiana University Health Pancreatic Cyst and Cancer Early Detection CenterIndianapolisUSA
  3. 3.Department of Pathology and Laboratory MedicineIndiana University School of MedicineIndianapolisUSA
  4. 4.Department of RadiologyIndiana University School of MedicineIndianapolisUSA
  5. 5.Department of Medicine, Division of GastroenterologyIndiana University School of MedicineIndianapolisUSA
  6. 6.Department of Biochemistry/Molecular BiologyIndiana University School of MedicineIndianapolisUSA
  7. 7.Walther Oncology CenterIndianapolisUSA
  8. 8.Indiana University Simon Cancer CenterIndianapolisUSA

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