Annals of Surgical Oncology

, Volume 20, Issue 2, pp 440–447 | Cite as

Malignant Progression in IPMN: A Cohort Analysis of Patients Initially Selected for Resection or Observation

  • J. LaFemina
  • N. Katabi
  • D. Klimstra
  • C. Correa-Gallego
  • S. Gaujoux
  • T. P. Kingham
  • R. P. DeMatteo
  • Y. Fong
  • M. I. D’Angelica
  • W. R. Jarnagin
  • R. K. Do
  • M. F. Brennan
  • Peter J. AllenEmail author
Pancreatic Tumors



Intraductal papillary mucinous neoplasms (IPMN) may represent a field defect of pancreatic ductal instability. The relative risk of carcinoma in regions remote from the radiographically identified cyst remains poorly defined. This study describes the natural history of IPMN in patients initially selected for resection or surveillance.


Patients with IPMN submitted to resection or radiographic surveillance were identified from a prospectively maintained database. Comparisons were made between these two groups.


From 1995 to 2010, a total of 356 of 1,425 patients evaluated for pancreatic cysts fulfilled inclusion criteria. Median follow-up for the entire cohort was 36 months. Initial resection was selected for 186 patients (52 %); 114 had noninvasive lesions and 72 had invasive disease. A total of 170 patients underwent initial nonoperative management. Median follow-up for this surveillance group was 40 months. Ninety-seven patients (57 % of those under surveillance) ultimately underwent resection, with noninvasive disease in 79 patients and invasive disease in 18. Five of the 18 (28 %) invasive lesions developed in a region remote from the monitored lesion. Ninety invasive carcinomas were identified in the entire population (25 %), ten of which developed the invasive lesion separate from the index cyst, representing 11 % with invasive disease.


Invasive disease was identified in 39 % of patients with IPMN selected for initial resection and 11 % of patients selected for initial surveillance. Ten patients developed carcinoma in a region separate from the radiographically identified IPMN, representing 2.8 % of the study population. Diagnostic, operative, and surveillance strategies for IPMN should consider risk not only to the index cyst but also to the entire gland.


Pancreatic Ductal Adenocarcinoma Intraductal Papillary Mucinous Neoplasm Invasive Disease Cyst Fluid Main Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • J. LaFemina
    • 1
  • N. Katabi
    • 2
  • D. Klimstra
    • 2
  • C. Correa-Gallego
    • 1
  • S. Gaujoux
    • 1
  • T. P. Kingham
    • 1
  • R. P. DeMatteo
    • 1
  • Y. Fong
    • 1
  • M. I. D’Angelica
    • 1
  • W. R. Jarnagin
    • 1
  • R. K. Do
    • 3
  • M. F. Brennan
    • 1
  • Peter J. Allen
    • 1
    Email author
  1. 1.Department of Surgical OncologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of PathologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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