The management of intraductal papillary mucinous neoplasms of the pancreas.

Published on Oct 1, 2019in Minerva Chirurgica1
· DOI :10.23736/S0026-4733.19.08145-8
Tommaso Pollini8
Estimated H-index: 8
(University of Verona),
Stefano Andrianello15
Estimated H-index: 15
(University of Verona)
+ 5 AuthorsRoberto Salvia57
Estimated H-index: 57
(University of Verona)
Sources
Abstract
Intraductal papillary mucinous neoplasms (IPMN) of the pancreas are one of the most common preneoplastic entities among pancreatic cystic neoplasms (PCN). Their incidence is increasing due to an extensive use of cross-sectional imaging, but management still remains controversial. Among IPMNs, the main duct (MD-IPMN) and mixed (MT-IPMN) types harbor a high risk of malignant degeneration requiring resection in most of cases. The branch duct type (BD-IPMN), on the other side, can be safely surveilled as surgical resection is limited to selected cases deemed at high risk of malignant progression according to specific clinical and radiological features. An accurate diagnosis and a correct assessment of malignant potential are often hard to achieve, and clinical management still relies on the experience of the gastroenterologist/surgeon that is called to choose between a major pancreatic resection burdened by high morbidity and mortality rates and a life-long surveillance. The purpose of this report is to summarize the available evidence supporting the current practice for the management of IPMN and to offer a useful practical guide from first observation to postoperative follow-up.
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References63
Newest
#1Yo-ichi Yamashita (Kumamoto University)H-Index: 47
#2Hirohisa Okabe (Kumamoto University)H-Index: 30
Last. Hideo BabaH-Index: 99
view all 14 authors...
BACKGROUND/AIM: Identifying malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas remains challenging. This study aimed to evaluate the usefulness of 18-fluorodeoxyglucose positron emission tomography/computed tomography (18-FDG PET/CT) in distinguishing malignant from benign IPMN of the pancreas. PATIENTS AND METHODS: The cases of 79 patients with IPMN of the pancreas who underwent surgical resections between 1996 and 2016 at our Institution were enrolled in the present r...
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#1Giovanni Marchegiani (University of Verona)H-Index: 32
#2Stefano Andrianello (University of Verona)H-Index: 15
Last. Roberto Salvia (University of Verona)H-Index: 26
view all 8 authors...
Abstract Background Very little is known about adjuvant chemotherapy for invasive Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas. The aim was to assess whether adjuvant chemotherapy affects survival. Methods Retrospective evaluation of invasive IPMNs. Patients treated with surgery alone or followed by adjuvant chemotherapy were compared in terms of survival. Results A total of 102 invasive IPMNs were analyzed. Median follow-up was 72 (5–318) months and 18.6% received adjuvant c...
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#1Ajay V. Maker (UIC: University of Illinois at Chicago)H-Index: 26
#2Vincent Hong Hu (UIC: University of Illinois at Chicago)H-Index: 1
Last. Stefan J. Green (UIC: University of Illinois at Chicago)H-Index: 48
view all 14 authors...
Background Current standard-of-care technologies, such as imaging and cyst fluid analysis, are unable to consistently distinguish intraductal papillary mucinous neoplasms (IPMNs) of the pancreas at high risk of pancreatic cancer from low-risk IPMNs. The objective was to create a single-platform assay to identify IPMNs that are at high risk for malignant progression. Study Design Building on the Verona International Consensus Conference branch duct IPMN biomarker review, additional protein, cytok...
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#1Pallavi Pandey (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 8
#2Ankur Pandey (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 9
Last. Ihab R. Kamel (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 77
view all 13 authors...
Objectives To evaluate the added value of diffusion-weighted imaging (DWI) on MRI in differentiating serous from mucin-producing pancreatic cystic neoplasms (PCNs).
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#1Rachel E. Simpson (IU: Indiana University)H-Index: 5
#2Eugene P. Ceppa (IU: Indiana University)H-Index: 25
Last. C. Max SchmidtH-Index: 28
view all 11 authors...
Objective(s) A dilated main pancreatic duct in the distal remnant after proximal pancreatectomy for intraductal papillary mucinous neoplasms (IPMN) poses a diagnostic dilemma. We sought to determine parameters predictive of remnant main-duct IPMN and malignancy during surveillance.
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#1Giovanni Marchegiani (University of Verona)H-Index: 32
#2Stefano Andrianello (University of Verona)H-Index: 15
Last. Roberto Salvia (University of Verona)H-Index: 26
view all 10 authors...
BACKGROUND: The prevalence of symptoms in pancreatic cystic neoplasms (PCNs) is mainly based on retrospective surgical series. The aim of this study is to describe the actual prevalence of symptoms in PCNs under surveillance. METHODS: Patients with PCNs under surveillance observed from 2015 to 2017 were submitted to magnetic resonance imaging (MRI) and a specific interview. An identical survey was carried out on a control population matched for age, sex, and comorbidities in which any pancreatic...
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#1Giovanni Marchegiani (University of Verona)H-Index: 32
#2Stefano Andrianello (University of Verona)H-Index: 15
Last. Roberto Salvia (University of Verona)H-Index: 57
view all 9 authors...
BACKGROUND: The association between risk of pancreatic cancer and a dilated main pancreatic duct (MPD) in intraductal papillary mucinous neoplasm (IPMN) is debated. The aim of this study was to assess the role of MPD size in predicting pancreatic cancer in resected IPMNs and those kept under surveillance. METHODS: All patients with IPMN referred to the Pancreas Institute, University of Verona Hospital Trust, from 2006 to 2016 were included. The primary endpoint was the occurrence of malignancy d...
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#1Suguru YamadaH-Index: 51
#2Tsutomu Fujii (University of Toyama)H-Index: 12
Last. Yasuhiro KoderaH-Index: 83
view all 16 authors...
ObjectivesThe aims of the study were to compare survival outcomes between patients with pancreatic ductal adenocarcinoma (PDAC) and invasive intraductal papillary mucinous neoplasms (IPMN) and to determine candidates for adjuvant chemotherapy.MethodsA total of 579 consecutive patients, including 375
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Background & Aims For patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs, cysts), it is a challenge to identify those at high risk for malignant lesions. We sought to identify factors associated with development of pancreatic cancer, focusing on neoplasm growth rate. Methods We performed a retrospective study of 189 patients with BD-IPMNs who underwent at least 2 contrast-enhanced cross-sectional imaging studies, 1 year or more apart, at a tertiary referral center from ...
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#1Giovanni Marchegiani (University of Verona)H-Index: 32
#2Stefano Andrianello (University of Verona)H-Index: 15
Last. Roberto Salvia (University of Verona)H-Index: 57
view all 13 authors...
Abstract Background Mural nodules (MNs) have a predominant role in the 2016 revision of the international guidelines on intraductal papillary mucinous neoplasms (IPMN) of the pancreas. The aim of this study was to evaluate MNs as predictors of invasive cancer (iCa) or high-grade dysplasia (HGD) in IPMNs and to investigate the role of MN size in risk prediction. Methods A PRISMA-compliant systematic review of the literature and meta-analysis on selected studies were conducted. The random effect m...
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Cited By1
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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...
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