Skip to main content

Advertisement

SpringerLink
Log in

Invasive IPMN and MCN: Same Organ, Sifferent Outcomes?

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

Abstract

Background

The efficacy of surgery for invasive mucinous neoplasms is unclear. We examined the natural history of invasive mucinous cystic neoplasms (MCN) and invasive intraductal papillary mucinous neoplasms (IPMN) in patients who underwent pancreatic resection.

Methods

The Surveillance, Epidemiology, and End Results (SEER) database (1996–2006) was queried for cases of resected invasive MCN and IPMN. Demographics, tumor characteristics, and overall survival were examined using log-rank analysis and multivariate Cox regression model.

Results

Of 185 MCN cases and 641 IPMN cases, 73% and 48%, respectively, were women (P < 0.0001). Most (73%) IPMN were in the head of the pancreas; most (64%) MCN were in the tail/body (P < 0.0001). Lymph node metastasis was more common for IPMN than MCN (46% vs. 24%, P < 0.0001). Overall survival after resection was better for patients with stage I MCN vs. stage I IPMN (P = 0.0005), and it was better for patients with node-negative MCN vs. node-negative IPMN (P = 0.0061). There was no significant difference in survival of patients with stage IIA MCN vs. stage IIA IPMN (P = 0.5964), stage IIB MCN vs. stage IIB IPMN (P = 0.2262), or node-positive MCN vs. node-positive IPMN (P = 0.2263). Age older than 65 years (hazards ratio (HR) 1.71, P = 0.0046), high tumor grade (HR 2.68, P < 0.0001), higher T stage (HR 2.11, P < 0.0001), and IPMN histology (HR 1.90, P = 0.0040) predicted worse outcome in node-negative patients.

Conclusions

Our findings suggest that survival is better after resection of invasive MCN versus invasive IPMN when disease is localized within the pancreas, but this difference disappears in the presence of nodal metastasis or extrapancreatic extension.

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

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol. 1978;69:573–80.

    CAS  PubMed  Google Scholar 

  2. Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999;23:410–22.

    Article  CAS  PubMed  Google Scholar 

  3. Kloppel G SE, Longnecker DS, Capella C, Sobin LH. Histological typing of tumors of the exocrine pancreas. New York: Springer, 1996.

    Google Scholar 

  4. Longnecker DAG, Hruban R, Intraductal papillary-mucinous neoplasms of the pancreas. Lyon: IARC, 2000.

    Google Scholar 

  5. Fritz S, Warshaw AL, Thayer SP. Management of mucin-producing cystic neoplasms of the pancreas. Oncologist. 2009;14:125–36.

    Article  PubMed  Google Scholar 

  6. Sahani DV, Miller JC, del Castillo CF, et al. Cystic pancreatic lesions: classification and management. J Am Coll Radiol. 2009;6:376–80.

    Article  PubMed  Google Scholar 

  7. Hruban RH, Takaori K, Klimstra DS, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:977–87.

    Article  PubMed  Google Scholar 

  8. Levy P, Jouannaud V, O’Toole D, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol. 2006;4:460–8.

    Article  PubMed  Google Scholar 

  9. Tanaka M, Kobayashi K, Mizumoto K, Yamaguchi K. Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol. 2005;40:669–75.

    Article  PubMed  Google Scholar 

  10. Wilentz RE, Albores-Saavedra J, Hruban RH. Mucinous cystic neoplasms of the pancreas. Semin Diagn Pathol. 2000;17:31–42.

    CAS  PubMed  Google Scholar 

  11. Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg. 2006;30:2236–45.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Salvia R, Fernandez-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678–85; discussion 685–7.

    Article  PubMed  Google Scholar 

  14. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239:788–97; discussion 797–9.

    Article  PubMed  Google Scholar 

  15. Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol. 2004;2:1026–31.

    Article  PubMed  Google Scholar 

  16. Crippa S, Salvia R, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;247:571–9.

    Article  PubMed  Google Scholar 

  17. Riall TS, Stager VM, Nealon WH, et al. Incidence of additional primary cancers in patients with invasive intraductal papillary mucinous neoplasms and sporadic pancreatic adenocarcinomas. J Am Coll Surg. 2007;204:803–13; discussion 813–4.

    Article  PubMed  Google Scholar 

  18. Fernandez-del Castillo C, Targarona J, Thayer SP, et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003;138:427–33; discussion 433–4.

    Article  PubMed  Google Scholar 

  19. Sarr MG, Murr M, Smyrk TC, et al. Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importance-current state-of-the-art and unanswered questions. J Gastrointest Surg. 2003;7:417-28.

    Article  PubMed  Google Scholar 

  20. Thompson LD, Becker RC, Przygodzki RM, et al. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol. 1999;23:1-16.

    Article  CAS  PubMed  Google Scholar 

  21. Murakami Y, Uemura K, Sudo T, et al. Invasive intraductal papillary-mucinous neoplasm of the pancreas: comparison with pancreatic ductal adenocarcinoma. J Surg Oncol. 2009;100:13-8.

    Article  PubMed  Google Scholar 

  22. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg. 2001;234:313–21; discussion 321–2.

    Article  CAS  PubMed  Google Scholar 

  23. Maire F, Hammel P, Terris B, et al. Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut. 2002;51:717–22.

    Article  CAS  PubMed  Google Scholar 

  24. Shimada K, Sakamoto Y, Sano T, et al. Invasive carcinoma originating in an intraductal papillary mucinous neoplasm of the pancreas: a clinicopathologic comparison with a common type of invasive ductal carcinoma. Pancreas. 2006;32:281–7.

    Article  PubMed  Google Scholar 

  25. Woo SM, Ryu JK, Lee SH, et al. Survival and prognosis of invasive intraductal papillary mucinous neoplasms of the pancreas: comparison with pancreatic ductal adenocarcinoma. Pancreas. 2008;36:50–5.

    Article  PubMed  Google Scholar 

  26. Fasanella KE, McGrath K. Cystic lesions and intraductal neoplasms of the pancreas. Best Pract Res Clin Gastroenterol. 2009;23:35–48.

    Article  PubMed  Google Scholar 

  27. Devaney K, Goodman ZD, Ishak KG. Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol. 1994;18:1078–91.

    Article  CAS  PubMed  Google Scholar 

  28. Tenti P, Romagnoli S, Pellegata NS, et al. Primary retroperitoneal mucinous cystoadenocarcinomas: an immunohistochemical and molecular study. Virchows Arch. 1994;424:53–7.

    Article  CAS  PubMed  Google Scholar 

  29. Carpizo DR, Allen PJ, Brennan MF. Current management of cystic neoplasms of the pancreas. Surgeon. 2008;6:298–307.

    Article  CAS  PubMed  Google Scholar 

  30. Conlon KC. Intraductal papillary mucinous tumors of the pancreas. J Clin Oncol. 2005;23:4518–23.

    Article  PubMed  Google Scholar 

  31. 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;6:17–32.

    Article  PubMed  Google Scholar 

  32. Jang JY, Kim SW, Lee SE, et al. Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol. 2008;15:199–205.

    Article  PubMed  Google Scholar 

  33. Salvia R, Crippa S, Falconi M, et al. Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut. 2007;56:1086–90.

    Article  PubMed  Google Scholar 

  34. Allen PJ, D’Angelica M, Gonen M, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006;244:572–82.

    PubMed  Google Scholar 

  35. Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg. 2000;231:205–12.

    Article  CAS  PubMed  Google Scholar 

  36. Chari ST, Yadav D, Smyrk TC, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology. 2002;123:1500–7.

    Article  PubMed  Google Scholar 

  37. Bendix Holme J, Jacobsen N, Rokkjaer M, Kruse A. Total pancreatectomy in six patients with intraductal papillary mucinous tumour of the pancreas: the treatment of choice. HPB (Oxford). 2001;3:257–62.

    CAS  Google Scholar 

  38. Bassi C, Sarr MG, Lillemoe KD, Reber HA. Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management. J Gastrointest Surg. 2008;12:645–50.

    Article  PubMed  Google Scholar 

  39. Artinyan A, Soriano PA, Prendergast C, et al. The anatomic location of pancreatic cancer is a prognostic factor for survival. HPB (Oxford). 2008;10:371–6.

    Google Scholar 

  40. Schwarz RE, Smith DD: Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol. 2006;13:1189–200.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported by funding from the Lincy Foundation (Los Angeles, CA; Dr. Kargozaran), the Davidow Charitable Fund (Los Angeles, CA), the William Randolph Hearst Foundations (San Francisco, CA), the Rod Fasone Memorial Cancer Fund (Indianapolis, IN), the Ruth and Martin H. Weil Fund (Los Angeles, CA), Mrs. Lois Rosen, the Lance Armstrong Foundation (Austin, TX), the John Wayne Cancer Foundation (Newport Beach, CA), and the Wrather Family Foundation (Los Alamos, CA). The authors thank Gwen Berry for editorial assistance.

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA, USA

    Hamed Kargozaran MD, Vu Vu BS, Partha Ray MD, Sanjay Bagaria MD, Shawn Steen MD, Xing Ye MS & Singh Gagandeep MD

  2. Director of Hepatobiliary and Pancreatic Surgery, John Wayne Cancer Institute, Santa Monica, CA, USA

    Singh Gagandeep MD

Authors
  1. Hamed Kargozaran MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vu Vu BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Partha Ray MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjay Bagaria MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shawn Steen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xing Ye MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Singh Gagandeep MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Singh Gagandeep MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kargozaran, H., Vu, V., Ray, P. et al. Invasive IPMN and MCN: Same Organ, Sifferent Outcomes?. Ann Surg Oncol 18, 345–351 (2011). https://doi.org/10.1245/s10434-010-1309-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-1309-4

Keywords

Search

Navigation