The Clinical Management of Main Duct Intraductal Papillary Mucinous Neoplasm of the Pancreas.

Published on Jan 1, 2019in Digestive Surgery2.588
· DOI :10.1159/000486869
Chiara Dal Borgo3
Estimated H-index: 3
(University of Verona),
Giampaolo Perri8
Estimated H-index: 8
(University of Verona)
+ 3 AuthorsClaudio Bassi111
Estimated H-index: 111
(University of Verona)
Sources
Abstract
Background: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas comprise a heterogeneous group of intraductal mucin-producing neoplasms representing a typical adenoma-to-carcinoma sequence. The involvement of the main pancreatic duct (MPD) is a feature of paramount importance, directly related to a more aggressive biology and a higher malignancy rate. Method: We review and discuss the clinical management of IPMNs with a MPD involvement, recalling the different consensus guidelines and addressing recent controversies in literature, presenting the current clinical practice in Verona Pancreas Institute. Results: All the aspects of surgical management were discussed, from the indication for surgery to the intraoperative management and the follow-up strategies. Conclusion: The management of presumed IPMNs involving the MPD at our Institution is in line with the International Association of Pancreatology 2012 guidelines, revised in 2016. Surgical resection proposed should achieve the complete removal of the tumor with negative margins. Despite a good prognosis in terms of survival of overall resected main duct intraductal papillary mucinous neoplasms, follow-up should not be discontinued.
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Newest
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#2Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
Last. Christopher L. Wolfgang (Johns Hopkins University)H-Index: 105
view all 10 authors...
Abstract The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant ch...
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#1Stefano Crippa (Marche Polytechnic University)H-Index: 61
#2Claudio Bassi (University of Verona)H-Index: 111
Last. Massimo Falconi (Marche Polytechnic University)H-Index: 106
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Objective To evaluate mid-term outcomes and predictors of survival in non-operated patients with pancreatic intraductal papillary mucinous neoplasms (IPMNs) with worrisome features or high-risk stigmata as defined by International Consensus Guidelines for IPMN. Reasons for non-surgical options were physicians’ recommendation, patient personal choice or comorbidities precluding surgery. Methods In this retrospective, multicentre analysis, IPMNs were classified as branch duct (BD) and main duct (M...
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#2Carlos Fernandez-del Castillo (Harvard University)H-Index: 101
Abstract The incidence of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas has been rising in the past 2 decades, driven mainly by the widespread use of cross-sectional imaging. IPMNs are intraductal mucin-producing neoplasms that involve the main pancreatic duct or its side branches and lack the ovarian stroma typically seen in mucinous cystic neoplasms. The International Association of Pancreatology released consensus guidelines in 2006 and 2012 providing clinical algorithms ba...
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Although incidental pancreatic cystic neoplasms are being diagnosed with increasing frequency, little is known about the accurate prevalence of pancreatic cysts in the general population. The aims of this study were to evaluate the crude prevalence rate of pancreatic cystic neoplasms in asymptomatic healthy adults, and calculate the age- and sex-adjusted nationwide prevalence rate. A total of 21,745 asymptomatic individuals who underwent abdominal computed tomography (CT) as a health screening e...
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Abstract With the widespread use and advances in radiographic imaging, Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are identified with increasing frequency. Although many studies have addressed its biology and treatment, true understanding of its natural history continues to elude us. Its malignant potential places careproviders in a clinical dilemma of balancing the morbidity of pancreatectomy against the risk of malignant transformation while under continuous surveillance....
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#2Ilaria Pergolini (Marche Polytechnic University)H-Index: 13
Last. Massimo Falconi (Marche Polytechnic University)H-Index: 106
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Background Segmental/diffuse dilatation of the main pancreatic duct (MPD) is the typical feature of combined/main-duct intraductal papillary mucinous neoplasms (CMD-IPMNs). MPD dilation in IPMNs may be also expression of mucus hypersecretion/obstructive chronic pancreatitis (OCP). The aim of this study was to evaluate the presence and extension of MPD involvement by tumor/OCP and assess the risk of overtreatment. Methods Retrospective analysis of suspected CMD-IPMNs resected between January 2009...
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#2Russell S. LewisH-Index: 10
Last. Charles M. VollmerH-Index: 67
view all 8 authors...
BACKGROUND The literature investigating pancreatic invasive intraductal papillary mucinous neoplasm (IPMN) has largely come from small institutional studies, preventing adequately powered comparisons of adjuvant therapy versus surgery alone (SA) within specific patient subgroups. METHODS Patients with resected, stage I through IV, invasive IPMN and conventional pancreatic ductal adenocarcinoma (PDAC) were identified in the National Cancer Data Base (1998-2010). Cox modeling of patients with inva...
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#1Volkan Adsay (Emory University)H-Index: 54
#2Mari Mino-Kenudson (Harvard University)H-Index: 97
Last. Ralph H. HrubanH-Index: 213
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Background: There are no established guidelines for pathologic diagnosis/reporting of intraductal papillary mucinous neoplasms (IPMNs). Design: An international multidisciplinary group, brought together by the Verona Pancreas Group in Italy-2013, was tasked to devise recommendations. Results: (1) Crucial to rule out invasive carcinoma with extensive (if not complete) sampling. (2) Invasive component is to be documented in a full synoptic report including its size, type, grade, and stage. (3) The...
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Last. Christopher L. WolfgangH-Index: 105
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Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency for some patients to present with multifocal disease and/or develop additional lesions over time argues in favor of a field defect and complicates surgical management decisions. Surgery usually consists of partial pancreatic resection, which leaves behind a pancreatic remnant at risk for recurrent disease and progression to cancer....
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#1Olca Basturk (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 54
#2Seung-Mo Hong (UOU: University of Ulsan)H-Index: 60
Last. Toru FurukawaH-Index: 56
view all 23 authors...
International experts met to discuss recent advances and to revise the 2004 recommendations for assessing and reporting precursor lesions to invasive carcinomas of the pancreas, including pancreatic intraepithelial neoplasia (PanIN), intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm, and other lesions. Consensus recommendations include the following: (1) To improve concordance and to align with practical consequences, a 2-tiered system (low vs. high grade) is proposed for ...
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Cited By4
Newest
A “pandemic” of incidentally discovered pancreatic cyst neoplasms (PCNs) is ongoing. Among PCNs, intraductal papillary mucinous cystic neoplasms (IPMNs) are the most common and with their complex biology could represent a precursor lesion of pancreatic cancer. Although multiple guidelines exist to guide their treatment, there are still many “gray areas” on indications for surgery for IPMNs. The current indications for surgery of IPMNs were reappraised, considering potential discrepancies between...
Source
#1Alex B. Blair (Johns Hopkins University)H-Index: 17
#2Ross M. Beckman (Johns Hopkins University)H-Index: 3
Last. Jin He (Johns Hopkins University)H-Index: 45
view all 11 authors...
BACKGROUND Main-duct (MD) intraductal papillary mucinous neoplasm (IPMN) is associated with malignancy risk. There is a lack of consensus on treatment (partial or total pancreatectomy) when the MD is diffusely involved. We sought to characterize the pancreatic remnant fate after partial pancreatectomy for non-invasive diffuse MD-IPMN. METHODS Consecutive patients with partial pancreatectomy for non-invasive MD-IPMN from 2004 to 2016 were analyzed. Diffuse MD-IPMN was defined by preoperative imag...
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#1Matteo Palmeri (UniPi: University of Pisa)H-Index: 13
#2Gregorio Di Franco (UniPi: University of Pisa)H-Index: 13
Last. Luca Morelli (UniPi: University of Pisa)H-Index: 22
view all 13 authors...
Abstract Background The extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs. Methods We retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patie...
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#1Andrea Caravati (University of Verona)H-Index: 3
#2Stefano Andrianello (University of Verona)H-Index: 15
Last. Giovanni Marchegiani (University of Verona)H-Index: 32
view all 8 authors...
Background and Aims:Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neop...
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