Abstract
Background
Intraductal papillary-mucinous neoplasms (IPMN) were officially introduced into the TNM classification in 1996. Based on a two-center database, we reevaluated histopathological findings, clinicopathological pattern, predictive markers for malignancy, and outcome.
Methods
Between 1996 and 2006, a total of 1424 pancreatic resections were performed in the University Hospitals Dresden and Mannheim. Pathologists of both institutions reviewed the IPMN diagnoses and other with cystic or solid tumor diagnoses. All possible markers, such as diabetes, jaundice, etc., were analyzed for prediction of malignancy. We performed a survival analysis based on the morphologic classification to determine the prognosis of IPMN.
Results
There were 43 patients of primarily diagnosed IPMN along with 1174 patients with diagnoses, such as ductal adenocarcinoma. In 207 patients, the diagnoses revealed other cystic or small solid tumors. A histopathological review of the latter patients revealed 54 IPMNs, resulting in a total of 97 IPMN patients (29 noninvasive, 68 invasive). All IPMN patients had a median survival of 36 months. Recurrence occurred more frequently in invasive IPMN. Predictive markers of malignancy were pain, preoperative weight loss, jaundice, and elevated CA 19.9. The strongest independent prognostic factor was invasive growth. The survival analysis revealed excellent prognosis for noninvasive IPMN.
Conclusions
Since the introduction of IPMN in 1996, even specialized centers have had to deal with a learning curve. By reevaluating all cystic or small solid tumors, centers can improve and their patients’ treatment can be optimized. Because the preoperative diagnostic methods are not sensitive enough to differentiate between benign and malignant lesions, surgery is advocated for all main duct IPMN, because they have a high malignant potential. For branch duct IPMN, surgery is advocated if the lesion is symptomatic, >3 cm, or has enlarged nodules.
Similar content being viewed by others
References
Haban G (1936) Papillomatose und carcinom des gangsystems der bauchspeicheldrüse. Virchows Arch 297:207–220
Caroli JHP, Mercardier M (1975) Papillome benin du canal de Wirsung. Med Chir Dig 4:163–166
Ohhashi KMY, Takekoshi T (1982) Four cases of mucin producing cancer of the pancreas on specific findings of the papilla of Vater. Prog Diag Endosc 20:348–351
Tanaka M (2004) Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and treatment. Pancreas 28:282–288
Tanaka M, Chari S, Adsay V et al (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32
Kloppel G, Longnecker DS, Capella C et al (1996) World Health Organization International histological typing of tumors of the exocrine pancreas. Springer-Verlag, Berlin, pp 1–61
Longnecker DSAG, Hruban RH, Kloppel G (2000) Intraductal papillary-mucinous neoplasms of the pancreas. World Health Organization Classification of Tumors. Pathology and genetics of tumors of the digestive system. IARC Press, Lyon, pp 237–241
Egawa S, Takeda K, Fukuyama S et al (2004) Clinicopathological aspects of small pancreatic cancer. Pancreas 28:235–240
Salvia R, Fernandez-del Castillo C, Bassi C et al (2004) Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 239:678–687
Raut CP, Cleary KR, Staerkel GA et al (2006) Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol 13:582–594
Falconi M, Salvia R, Bassi C et al (2001) Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg 88:376–381
Kaplan ELMP (1958) Nonparametric estimation from incomplete observation. Am Stat Assoc 1958:457
Cox DR (1972) Regression models and life tables. J R Stat Soc 187
Richter A, Niedergethmann M, Lorenz D et al (2002) Resection for cancers of the pancreatic head in patients aged 70 years or over. Eur J Surg 168:339–344
Richter A, Niedergethmann M, Sturm JW et al (2003) Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg 27:324–329
Niedergethmann M, Farag Soliman M, Post S (2004) Postoperative complications of pancreatic cancer surgery. Minerva Chir 59:175–183
Niedergethmann M, Richter A, Wendl K (2001) Rare indications for a Kausch-Whipple procedure. Eur J Surg 167:115–119
Niedergethmann M, Shang E, Farag Soliman M et al (2006) Early and enduring nutritional and functional results of pylorus preservation vs classic Whipple procedure for pancreatic cancer. Langenbecks Arch Surg 391:195–202
Hara T, Yamaguchi T, Ishihara T et al (2002) Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 122:34–43
Hibi Y, Fukushima N, Tsuchida A et al (2007) Pancreatic juice cytology and subclassification of intraductal papillary mucinous neoplasms of the pancreas. Pancreas 34:197–204
Kubo H, Chijiiwa Y, Akahoshi K et al (2001) Intraductal papillary-mucinous tumors of the pancreas: differential diagnosis between benign and malignant tumors by endoscopic ultrasonography. Am J Gastroenterol 96:1429–1434
Raimondo M, Tachibana I, Urrutia R et al (2002) Invasive cancer and survival of intraductal papillary mucinous tumors of the pancreas. Am J Gastroenterol 97:2553–2558
Sugiyama M, Atomi Y (1998) Intraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg 228:685–691
Murakami Y, Uemura K, Hayashidani Y et al (2007) Predictive factors of malignant or invasive intraductal papillary-mucinous neoplasms of the pancreas. J Gastrointest Surg 11:338–344
Okabayashi T, Kobayashi M, Nishimori I et al (2006) Clinicopathological features and medical management of intraductal papillary mucinous neoplasms. J Gastroenterol Hepatol 21:462–467
Sohn TA, Yeo CJ, Cameron JL et al (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–799
Serikawa M, Sasaki T, Fujimoto Y et al (2006) Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification. J Clin Gastroenterol 40:856–862
Shima Y, Mori M, Takakura N et al (2000) Diagnosis and management of cystic pancreatic tumours with mucin production. Br J Surg 87:1041–1047
Sugiyama M, Izumisato Y, Abe N et al (2003) Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 90:1244–1249
Rodriguez JR, Salvia R, Crippa S et al (2007) Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 133:72–9 quiz 309–10
Schmidt CM, White PB, Waters JA et al (2007) Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg 246:644–654
Maire F, Hammel P, Terris B et al (2002) Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut 51:717–722
Chari ST, Yadav D, Smyrk TC et al (2002) Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology 123:1500–1507
Doi R, Fujimoto K, Wada M et al (2002) Surgical management of intraductal papillary mucinous tumor of the pancreas. Surgery 132:80–85
Hundahl SA, Fleming ID, Fremgen AM et al (1998) A National Cancer Data Base report on 53, 856 cases of thyroid carcinoma treated in the U.S., 1985–1995 [see comments]. Cancer 83:2638–2648
Cuillerier E, Cellier C, Palazzo L et al (2000) Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol 95:441–445
Bernard P, Scoazec JY, Joubert M et al (2002) Intraductal papillary-mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg 137:1274–1278
Brugge WR, Lauwers GY, Sahani D, Fernadez-del Castillo C, Warshaw AL (2004) Cystic neoplasms of the pancreas. N Engl J Med 351:1218–1226
Matsumoto T, Aramaki M, Yada K, Hirano S, Himeno Y, Shibata K, Kawano K, Kitano S (2003) Optimal management of the branch type intraductal papillary mucinous tumours of the pancreas. J Clin Gastroenterol 36:261–265
Hartel M, Niedergethmann M, Farag-Soliman M et al (2002) Benefit of venous resection for ductal adenocarcinoma of the pancreatic head. Eur J Surg 168:707–712
Author information
Authors and Affiliations
Corresponding author
Additional information
Marco Niedergethmann and Robert Grützmann contributed equally to this work.
Rights and permissions
About this article
Cite this article
Niedergethmann, M., Grützmann, R., Hildenbrand, R. et al. Outcome of Invasive and Noninvasive Intraductal Papillary-Mucinous Neoplasms of the Pancreas (IPMN): A 10-year Experience. World J Surg 32, 2253–2260 (2008). https://doi.org/10.1007/s00268-008-9692-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-008-9692-8