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Multicenter Analysis of Clinicopathologic Features of Intraductal Papillary Mucinous Tumor of the Pancreas: Is It Possible to Predict the Malignancy Before Surgery?

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Abstract

Background

Despite recently increasing numbers of reports on intraductal papillary mucinous tumors (IPMTs), difficulties still remain in terms of diagnosis, treatment, and prognosis. The purpose of this multicenter study was to evaluate the clinicopathologic features of IPMT in Korea and to suggest predictive criteria for malignancy in IPMT.

Methods

We retrospectively reviewed the clinicopathologic data of 208 patients who underwent operations for IPMT between 1993 and 2002 at 28 institutes in Korea.

Results

Of the 208 patients (mean age, 61 years), 147 were men and 61 were women. A total of 124 patients underwent pancreatoduodenectomy, 42 underwent distal pancreatectomy, 17 underwent total pancreatectomy, and 25 underwent limited pancreatic resection. There were 128 benign cases (adenoma, n = 62; borderline, n = 66) and 80 malignant cases (noninvasive, n = 29; invasive, n = 51). A significant difference in 5-year survival was observed between the benign and malignant groups (92.6% vs. 65.3%; P = .006). Of the six factors (age, location, duct dilatation, mural nodule, main duct type, and tumor size) that showed statistical differences by univariate analysis between the benign and malignant groups, three were significant by multivariate analysis—namely, mural nodule (P = .009), tumor size (P = .023), and a dilated duct size (P = .010).

Conclusions

A significant proportion of IPMTs are malignant, although the overall prognosis of IPMT is superior to that of ordinary pancreatic cancer. Radical surgery is recommended for IPMT with the predictors of malignancy: mural nodule, tumor size (⩾30 mm), and dilated duct size (⩾12 mm).

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References

  1. K Ohhashi F Murakami M Murayama et al. (1982) ArticleTitleFour cases of mucin-producing cancer of the pancreas on specific findings of the papilla of Vater (in Japanese) Prog Dig Endosc 20 348–51

    Google Scholar 

  2. M Sugiyama Y Atomi (1998) ArticleTitleIntraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies Ann Surg 228 685–91 Occurrence Handle1:STN:280:DyaK1M%2FkvFGmsQ%3D%3D Occurrence Handle9833807

    CAS  PubMed  Google Scholar 

  3. K Yamaguchi M Tanaka (1991) ArticleTitleMucin-hypersecreting tumor of the pancreas with mucin extrusion through an enlarged papilla Am J Gastroenterol 86 835–9 Occurrence Handle1:STN:280:DyaK3M3otFOltQ%3D%3D Occurrence Handle2058624

    CAS  PubMed  Google Scholar 

  4. T Obara H Maguchi Y Saitoh et al. (1991) ArticleTitleMucin-producing tumor of the pancreas: a unique clinical entity Am J Gastroenterol 86 1619–25 Occurrence Handle1:STN:280:DyaK38%2FlvV2jtg%3D%3D Occurrence Handle1659183

    CAS  PubMed  Google Scholar 

  5. M Sugiyama Y Izumisato N Abe T Masaki T Mori Y Atomi (2003) ArticleTitlePredictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas Br J Surg 90 1244–9 Occurrence Handle1:STN:280:DC%2BD3svltl2htg%3D%3D Occurrence Handle14515294

    CAS  PubMed  Google Scholar 

  6. JM McDonald W Williard D Mais A Beitler (2000) ArticleTitleThe incidence of intraductal papillary mucinous tumors of the pancreas Curr Surg 57 610–4 Occurrence Handle11120307

    PubMed  Google Scholar 

  7. E Nagai T Ueki K Chijiiwa M Tanaka M Tsuneyoshi (1995) ArticleTitleIntraductal papillary mucinous neoplasms of the pancreas associated with so-called “mucinous ductal ectasia.” Histochemical and immunohistochemical analysis of 29 cases Am J Surg Pathol 19 576–89 Occurrence Handle10.1097/00000478-199505000-00010 Occurrence Handle1:STN:280:DyaK2M3ktlCnsg%3D%3D Occurrence Handle7726368

    Article  CAS  PubMed  Google Scholar 

  8. C Azar J Stadt F Rickaert et al. (1996) ArticleTitleIntraductal papillary mucinous tumours of the pancreas. Clinical and therapeutic issues in 32 patients Gut 39 457–64 Occurrence Handle1:STN:280:DyaK2s7gs12jtA%3D%3D Occurrence Handle8949654

    CAS  PubMed  Google Scholar 

  9. LW Traverso EA Peralta JA Ryan SuffixJr RA Kozarek (1998) ArticleTitleIntraductal neoplasms of the pancreas Am J Surg 175 426–32 Occurrence Handle1:STN:280:DyaK1c3mtV2hsg%3D%3D Occurrence Handle9600293

    CAS  PubMed  Google Scholar 

  10. E Cuillerier C Cellier L Palazzo et al. (2000) ArticleTitleOutcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas Am J Gastroenterol 95 441–5 Occurrence Handle1:STN:280:DC%2BD3c7kvVWrsQ%3D%3D Occurrence Handle10685747

    CAS  PubMed  Google Scholar 

  11. T Hara T Yamaguchi T Ishihara et al. (2002) ArticleTitleDiagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography Gastroenterology 122 34–43 Occurrence Handle11781278

    PubMed  Google Scholar 

  12. T Wakabayashi Y Kawaura H Morimoto et al. (2001) ArticleTitleClinical management of intraductal papillary mucinous tumors of the pancreas based on imaging findings Pancreas 22 370–7 Occurrence Handle1:STN:280:DC%2BD3M3ktFansw%3D%3D Occurrence Handle11345137

    CAS  PubMed  Google Scholar 

  13. K Z’graggen JA Rivera CC Compton et al. (1997) ArticleTitlePrevalence of activating K-ras mutations in the evolutionary stages of neoplasia in intraductal papillary mucinous tumors of the pancreas Ann Surg 226 491–8 Occurrence Handle10.1097/00000658-199710000-00010 Occurrence Handle9351717

    Article  PubMed  Google Scholar 

  14. H Kondo K Sugano N Fukayama et al. (1997) ArticleTitleDetection of K-ras gene mutations at codon 12 in the pancreatic juice of patients with intraductal papillary mucinous tumors of the pancreas Cancer 79 900–5 Occurrence Handle1:STN:280:DyaK2s7ptlGltA%3D%3D Occurrence Handle9041151

    CAS  PubMed  Google Scholar 

  15. M Kaino S Kondoh S Okita et al. (1999) ArticleTitleDetection of K-ras and p53 gene mutations in pancreatic juice for the diagnosis of intraductal papillary mucinous tumors Pancreas 18 294–9 Occurrence Handle1:STN:280:DyaK1M3itFehuw%3D%3D Occurrence Handle10206488

    CAS  PubMed  Google Scholar 

  16. AV Biankin SA Biankin JG Kench et al. (2002) ArticleTitleAberrant p16(INK4A) and DPC4/Smad4 expression in intraductal papillary mucinous tumours of the pancreas is associated with invasive ductal adenocarcinoma Gut 50 861–8 Occurrence Handle10.1136/gut.50.6.861 Occurrence Handle1:CAS:528:DC%2BD38XkvVGktLw%3D Occurrence Handle12010891

    Article  CAS  PubMed  Google Scholar 

  17. H Inoue A Tsuchida Y Kawasaki Y Fujimoto S Yamasaki G Kajiyama (2001) ArticleTitlePreoperative diagnosis of intraductal papillary-mucinous tumors of the pancreas with attention to telomerase activity Cancer 91 35–41 Occurrence Handle10.1002/1097-0142(20010101)91:1<35::AID-CNCR5>3.0.CO;2-A Occurrence Handle1:STN:280:DC%2BD38%2Fgs1SltA%3D%3D Occurrence Handle11148557

    Article  CAS  PubMed  Google Scholar 

  18. J Luttges B Feyerabend T Buchelt M Pacena G Kloppel (2002) ArticleTitleThe mucin profile of noninvasive and invasive mucinous cystic neoplasms of the pancreas Am J Surg Pathol 26 466–71 Occurrence Handle1:STN:280:DC%2BD387otFGksQ%3D%3D Occurrence Handle11914624

    CAS  PubMed  Google Scholar 

  19. P Bernard JY Scoazec M Joubert et al. (2002) ArticleTitleIntraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases Arch Surg 137 1274–8 Occurrence Handle12413317

    PubMed  Google Scholar 

  20. K Yamaguchi Y Ogawa K Chijiiwa M Tanaka (1996) ArticleTitleMucin-hypersecreting tumors of the pancreas: assessing the grade of malignancy preoperatively Am J Surg 171 427–31 Occurrence Handle1:STN:280:DyaK287ns12qtA%3D%3D Occurrence Handle8604836

    CAS  PubMed  Google Scholar 

  21. T Furukawa T Takahashi M Kobari S Matsuno (1992) ArticleTitleThe mucus-hypersecreting tumor of the pancreas. Development and extension visualized by three-dimensional computerized mapping Cancer 70 1505–13 Occurrence Handle1:STN:280:DyaK38zos1Citw%3D%3D Occurrence Handle1516002

    CAS  PubMed  Google Scholar 

  22. S Itoh T Ishiguchi T Ishigaki S Sakuma K Maruyama K Senda (1992) ArticleTitleMucin-producing pancreatic tumor: CT findings and histopathologic correlation Radiology 183 81–6 Occurrence Handle1:STN:280:DyaK387ps1ehsg%3D%3D Occurrence Handle1312735

    CAS  PubMed  Google Scholar 

  23. T Obara H Maguchi Y Saitoh et al. (1993) ArticleTitleMucin-producing tumor of the pancreas: natural history and serial pancreatogram changes Am J Gastroenterol 88 564–9 Occurrence Handle1:STN:280:DyaK3s3ivVSgsA%3D%3D Occurrence Handle8385881

    CAS  PubMed  Google Scholar 

  24. M Kobari S Egawa K Shibuya et al. (1999) ArticleTitleIntraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management Arch Surg 134 1131–6 Occurrence Handle1:STN:280:DyaK1MvltVKqtw%3D%3D Occurrence Handle10522860

    CAS  PubMed  Google Scholar 

  25. T Kamisawa T Fujiwara Y Tu et al. (2002) ArticleTitleLong-term follow-up of intraductal papillary adenoma of the pancreas J Gastroenterol 37 868–73 Occurrence Handle12424574

    PubMed  Google Scholar 

  26. N Kanazumi A Nakao T Kaneko et al. (2001) ArticleTitleSurgical treatment of intraductal papillary-mucinous tumors of the pancreas Hepatogastroenterology 48 967–71 Occurrence Handle1:STN:280:DC%2BD3MvksFOmtQ%3D%3D Occurrence Handle11490850

    CAS  PubMed  Google Scholar 

  27. ST Chari D Yadav TC Smyrk et al. (2002) ArticleTitleStudy of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas Gastroenterology 123 1500–7 Occurrence Handle12404225

    PubMed  Google Scholar 

  28. M Sugiyama Y Atomi (1999) ArticleTitleExtrapancreatic neoplasms occur with unusual frequency in patients with intraductal papillary mucinous tumors of the pancreas Am J Gastroenterol 94 470–3 Occurrence Handle1:STN:280:DyaK1M7ksFantA%3D%3D Occurrence Handle10022648

    CAS  PubMed  Google Scholar 

  29. DJ Brat KD Lillemoe CJ Yeo PB Warfield RH Hruban (1998) ArticleTitleProgression of pancreatic intraductal neoplasias to infiltrating adenocarcinoma of the pancreas Am J Surg Pathol 22 163–9 Occurrence Handle1:STN:280:DyaK1c7lvFymsA%3D%3D Occurrence Handle9500216

    CAS  PubMed  Google Scholar 

  30. K Yamaguchi J Ohuchida T Ohtsuka K Nakano M Tanaka (2002) ArticleTitleIntraductal papillary-mucinous tumor of the pancreas concomitant with ductal carcinoma of the pancreas Pancreatology 2 484–90 Occurrence Handle12378117

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Drs. Young Kook Yun (Kyungpook National University); Soon Chan Hong (Gyengsang National University); Koo Jeong Kang (Keimyung University); Kyong Woo Choi (National Medical Center); Yong Oon Yoo (Catholic University of Daegu); Jong Hun Park (Daegu Fatima Hospital); Young Hoon Kim (Dong-A University); Mun Sup Sim (Pusan National University); Hyung Chul Kim, Chang Ho Kim, and Man Kyu Chae (Soonchunhyang University); Hong Yong Kim and Young Gil Choi (Inje University); Kwon Mook Chae (Wonkwang University); Dong Wook Choi (Korea Cancer Center Hospital); Ho Seong Han (Ewha Women University); Seung Ik Ahn (Inha University); Kuk Hwan Kwon (National Health Insurance Corporation Ilsan Hospital); Jae Woon Choi (Chungbuk National University); Jong Riul Lee (Cheonju St. Mary’s Hospital); and Joo Seop Kim (Hallym University) for their cooperation in the conduction this study. They generously provided important clinicopathologic information about patients with IPMT.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Hospital, 28 Yongon-dong, Changno-gu, 110-744, Seoul, Korea

    Jin-Young Jang MD, Sun-Whe Kim MD, FACS, Young Joon Ahn MD, Yoo-Seok Yoon MD, Min Gew Choi MD, Kuhn Uk Lee MD, Myung-Wook Kim MD & Yong-Hyun Park MD

  2. Department of Radiology, Seoul National University, Seoul, 110-744, Korea

    Joon Koo Han MD

  3. Department of Pathology, Seoul National University, Seoul, 110-744, Korea

    Woo Ho Kim MD

  4. Department of Surgery, Ulsan University, Seoul, 138-736, Korea

    Young Joo Lee MD, Song Chul Kim MD & Duck Jong Han MD

  5. Department of Surgery, Sungkyunkwan University, Seoul, 135-710, Korea

    Yong Il Kim MD & Seong Ho Choi MD

  6. Department of Surgery, Chonbuk National University, Jeonju, 561-712, Korea

    Baik Hwan Cho MD & Hee Chul Yu MD

  7. Department of Surgery, Yonsei University, Seoul, 120-752, Korea

    Dong Sup Yoon MD & Woo Jung Lee MD

  8. Department of Surgery, Korea University, Seoul, 136-701, Korea

    Kyung Bum Lee MD & Young Chul Kim MD

  9. Department of Surgery, Hanyang University, Seoul, 133-792, Korea

    Kwang Soo Lee MD

  10. Department of Surgery, Yeungnam University, Daegu, 705-717, Korea

    Hong Jin Kim MD

  11. Department of Surgery, Chonnam National University, Gwangju, 501-757, Korea

    Hyun Jong Kim MD

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  1. Jin-Young Jang MD
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  2. Sun-Whe Kim MD, FACS
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  3. Young Joon Ahn MD
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  12. Yong Il Kim MD
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  14. Baik Hwan Cho MD
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  15. Hee Chul Yu MD
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  16. Dong Sup Yoon MD
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  19. Young Chul Kim MD
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  20. Kwang Soo Lee MD
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  21. Myung-Wook Kim MD
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  24. Yong-Hyun Park MD
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Corresponding author

Correspondence to Sun-Whe Kim MD, FACS.

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Jang, JY., Kim, SW., Ahn, Y.J. 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 12, 124–132 (2005). https://doi.org/10.1245/ASO.2005.02.030

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  • DOI: https://doi.org/10.1245/ASO.2005.02.030

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