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Laparoscopic vs. Open Resection of Noninvasive Intraductal Pancreatic Mucinous Neoplasms

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Required resection margins for noninvasive intraductal papillary mucinous neoplasms (IPMNs) are a controversial issue. Over a 10-year period we have resected IPMNs from the entire pancreatic gland with minimally invasive techniques and compared our survival and complication rates with open controls to see if any difference in resection margins and outcomes could be observed. Data were collected retrospectively, including our first cases of advanced laparoscopic resections. Five-year Kaplan–Meier curves were calculated and statistical analysis was performed using the log rank and Student’s T test for continuous variables. Chi square and Fisher’s exact tests were used for analyzing categorical variables. From March 1997 to Febuary 2006, we operated on 22 patients with noninvasive IPMNs, of which 9 (41%) were operated on laparoscopically and 13 (59%) using open techniques. Three patients underwent laparoscopic duodenopancreatectomy, compared to five in the open group. All resection margins were negative, but two patients required total pancreatectomy, both of which were performed laparoscopically. One of these was converted to open (11%) because of difficulty in reconstructing the biliary anastomosis. The overall complication rates were 56% for the laparoscopic group and 85% for the open group. Twenty-two percent of the laparoscopic group required reoperation and 11% required percutaneous drainage, compared to 15 and 23% in the open group, respectively. All patients are alive after a mean of 20 months (range = 2–43) in the laparoscopic group and 37 months (range = 1–121) in the open one (p > 0.05). Laparoscopic resection of noninvasive IPMNs of the entire pancreatic gland has similar complication and survival rates as open procedures. As a result, the laparoscopic approach is appropriate for noninvasive IPMNs of the entire pancreatic gland; however, larger cohorts are needed to see if any approach has superior outcomes. Because of these favorable results, studies are currently underway to see if the minimally invasive approach is also appropriate for invasive IPMNs.

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References

  1. Raut CP, Cleary KR, Staerkel GA, et al. Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol 2006;13(4):582–594.

    Article  PubMed  Google Scholar 

  2. Furukawa T, Kloppel G, Volkan Adsay N, et al. Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch 2005;447(5):794–799.

    Article  PubMed  Google Scholar 

  3. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 2004;239(6):788–797; discussion 797–789.

    Article  PubMed  Google Scholar 

  4. 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(1–2):17–32.

    Article  PubMed  Google Scholar 

  5. 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(12):2236–2245.

    Article  PubMed  Google Scholar 

  6. Fujino Y, Suzuki Y, Yoshikawa T, et al. Outcomes of surgery for intraductal papillary mucinous neoplasms of the pancreas. World J Surg 2006;30(10):1909–1914; discussion 1915.

    Article  PubMed  Google Scholar 

  7. Serikawa M, Sasaki T, Fujimoto Y, Kuwahara K, Chayama K. Management of intraductal papillary-mucinous neoplasm of the pancreas: treatment strategy based on morphologic classification. J Clin Gastroenterol 2006;40(9):856–862.

    Article  PubMed  Google Scholar 

  8. Pelaez-Luna M, Chari ST, Smyrk TC, et al. Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol 2007;102(8):1759–1764.

    Article  PubMed  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–213.

    Article  PubMed  Google Scholar 

  10. 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(5):678–685; discussion 685–677.

    Article  PubMed  Google Scholar 

  11. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Sueda T. Predictive factors of malignant or invasive intraductal papillary-mucinous neoplasms of the pancreas. J Gastrointest Surg 2007;11(3):338–344.

    Article  PubMed  Google Scholar 

  12. Fujii T, Ishikawa T, Kanazumi N, et al. Analysis of clinicopathological features and predictors of malignancy in intraductal papillary mucinous neoplasms of the pancreas. Hepatogastroenterology 2007;54(73):272–277.

    PubMed  Google Scholar 

  13. Kobayashi G, Fujita N, Noda Y, et al. Mode of progression of intraductal papillary-mucinous tumor of the pancreas: analysis of patients with follow–up by EUS. J Gastroenterol 2005;40(7):744–751.

    Article  PubMed  Google Scholar 

  14. Ban S, Naitoh Y, Mino-Kenudson M, et al. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol 2006;30(12):1561–1569.

    Article  PubMed  Google Scholar 

  15. Tanaka M, Kobayashi K, Mizumoto K, Yamaguchi K. Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol 2005;40(7):669–675.

    Article  PubMed  Google Scholar 

  16. Couvelard A, Sauvanet A, Kianmanesh R, et al. Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation. Ann Surg 2005;242(6):774–778; discussion 778–780.

    Article  PubMed  Google Scholar 

  17. White R, D’Angelica M, Katabi N, et al. Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm. J Am Coll Surg 2007;204(5):987–993.

    Article  PubMed  Google Scholar 

  18. Corvera CU, Dunnican WJ, Blumgart LH, D’Angelica M. Recurrent invasive intraductal papillary mucinous carcinoma of the pancreas mimicking pott disease: review of the literature. Pancreas 2006;32(3):321–324.

    Article  PubMed  Google Scholar 

  19. Wang SE, Shyr YM, Chen TH, et al. Comparison of resected and non-resected intraductal papillary mucinous neoplasms of the pancreas. World J Surg 2005;29(12):1650–1657.

    Article  PubMed  Google Scholar 

  20. Wada K, Kozarek RA, Traverso LW. Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas. Am J Surg 2005;189(5):632–636; discussion 637.

    Article  PubMed  Google Scholar 

  21. Kawamoto S, Horton KM, Lawler LP, Hruban RH, Fishman EK. Intraductal papillary mucinous neoplasm of the pancreas: can benign lesions be differentiated from malignant lesions with multidetector CT? Radiographics 2005;25(6):1451–1468; discussion 1468–1470.

    Article  PubMed  Google Scholar 

  22. Yeh TS, Tseng JH, Chiu CT, et al. Cholangiographic spectrum of intraductal papillary mucinous neoplasm of the bile ducts. Ann Surg 2006;244(2):248–253.

    Article  PubMed  Google Scholar 

  23. Michaels PJ, Brachtel EF, Bounds BC, Brugge WR, Pitman MB. Intraductal papillary mucinous neoplasm of the pancreas: cytologic features predict histologic grade. Cancer 2006;108(3):163–173.

    Article  PubMed  Google Scholar 

  24. Emerson RE, Randolph ML, Cramer HM. Endoscopic ultrasound-guided fine-needle aspiration cytology diagnosis of intraductal papillary mucinous neoplasm of the pancreas is highly predictive of pancreatic neoplasia. Diagn Cytopathol 2006;34(7):457–462.

    Article  PubMed  Google Scholar 

  25. 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(8):977–987.

    Article  PubMed  Google Scholar 

  26. Salvia R, Crippa S, Falconi M, et al. Branch–duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Results of a prospective protocol on the management of 109 consecutive patients. Gut 2007;56:1086–1090.

    Article  PubMed  Google Scholar 

  27. Okabayashi T, Kobayashi M, Nishimori I, et al. Clinicopathological features and medical management of intraductal papillary mucinous neoplasms. J Gastroenterol Hepatol 2006;21(2):462–467.

    Article  PubMed  Google Scholar 

  28. Warshaw L. Conservation of the spleen with distal pancreatectomy. Arch Surg 1998;123:550–553.

    Google Scholar 

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Acknowledgements

Andrew A. Gumbs, MD, was supported by a fellowship grant from KARL STORZ GmbH & Co. KG, Tuttlingen, Germany. This work was supported by grants from the Association pour la Recherche contre le Cancer of France and the Philippe Foundation in Paris, France.

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  1. Department of Medical and Surgical Digestive Diseases, Institut Mutualiste Montsouris, University Paris V, 42 Boulevard Jourdan, Paris, 75014, France

    Andrew A. Gumbs, Philippe Grès, Fabio A. Madureira & Brice Gayet

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  1. Andrew A. Gumbs
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  2. Philippe Grès
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Correspondence to Brice Gayet.

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Gumbs, A.A., Grès, P., Madureira, F.A. et al. Laparoscopic vs. Open Resection of Noninvasive Intraductal Pancreatic Mucinous Neoplasms. J Gastrointest Surg 12, 707–712 (2008). https://doi.org/10.1007/s11605-007-0311-z

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  • DOI: https://doi.org/10.1007/s11605-007-0311-z

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