TY - JOUR
T1 - Branch-Duct Intraductal Papillary Mucinous Neoplasms
T2 - Observations in 145 Patients Who Underwent Resection
AU - Rodriguez, J. Ruben
AU - Salvia, Roberto
AU - Crippa, Stefano
AU - Warshaw, Andrew L.
AU - Bassi, Claudio
AU - Falconi, Massimo
AU - Thayer, Sarah P.
AU - Lauwers, Gregory Y.
AU - Capelli, Paola
AU - Mino-Kenudson, Mari
AU - Razo, Oswaldo
AU - McGrath, Deborah
AU - Pederzoli, Paolo
AU - Fernández-Del Castillo, Carlos
N1 - Funding Information:
Supported by Cariverona, Fondazione Giorgio Zanotto, and COFIN 2005060715_004, MIUR, Roma, Italy, and by the International Hepato-Pancreato-Biliary Association (IHPBA; to S.C.) and the Fondazione Italiana Malattie Pancreas (to S.C.).
PY - 2007/6
Y1 - 2007/6
N2 - Background & Aims: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas arising in branch ducts are thought to be less aggressive than their main-duct counterparts, and guidelines for their conservative management were recently proposed. This study describes the combined experience of 2 tertiary centers with branch-duct IPMNs aiming to validate these recommendations. Methods: A review of 145 patients with resected, pathologically confirmed, branch-duct IPMNs between 1990 and 2005 was conducted. Results: Sixty-six patients (45.5%) had adenoma, 47 (32%) borderline tumors, 16 (11%) carcinoma in situ, and 16 (11%) invasive carcinoma. Median age was similar between benign and malignant subgroups (66 vs 67.5 years, respectively). Jaundice was more frequent in patients with cancer (12.5% vs 1.8%, respectively, P = .022) and abdominal pain in patients with benign tumors (45% vs 25%, respectively, P = .025). Forty percent of tumors were discovered incidentally. Findings associated with malignancy were the presence of a thick wall (P < .001), nodules (P < .001), and tumor diameter ≥30 mm (P < .001). All neoplasms with cancer were larger than 30 mm in size or had nodules or caused symptoms. After a mean follow-up of 45 months, the 5-year disease-specific survival for branch-duct IPMNs with noninvasive neoplasms was 100% and, for invasive cancer, was 63%. Conclusions: This large cohort of resected branch-duct IPMNs shows that cancer is present in 22% of cases and validates the recent guidelines that indicate absence of malignancy in tumors <30 mm, without symptoms or mural nodules.
AB - Background & Aims: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas arising in branch ducts are thought to be less aggressive than their main-duct counterparts, and guidelines for their conservative management were recently proposed. This study describes the combined experience of 2 tertiary centers with branch-duct IPMNs aiming to validate these recommendations. Methods: A review of 145 patients with resected, pathologically confirmed, branch-duct IPMNs between 1990 and 2005 was conducted. Results: Sixty-six patients (45.5%) had adenoma, 47 (32%) borderline tumors, 16 (11%) carcinoma in situ, and 16 (11%) invasive carcinoma. Median age was similar between benign and malignant subgroups (66 vs 67.5 years, respectively). Jaundice was more frequent in patients with cancer (12.5% vs 1.8%, respectively, P = .022) and abdominal pain in patients with benign tumors (45% vs 25%, respectively, P = .025). Forty percent of tumors were discovered incidentally. Findings associated with malignancy were the presence of a thick wall (P < .001), nodules (P < .001), and tumor diameter ≥30 mm (P < .001). All neoplasms with cancer were larger than 30 mm in size or had nodules or caused symptoms. After a mean follow-up of 45 months, the 5-year disease-specific survival for branch-duct IPMNs with noninvasive neoplasms was 100% and, for invasive cancer, was 63%. Conclusions: This large cohort of resected branch-duct IPMNs shows that cancer is present in 22% of cases and validates the recent guidelines that indicate absence of malignancy in tumors <30 mm, without symptoms or mural nodules.
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U2 - 10.1053/j.gastro.2007.05.010
DO - 10.1053/j.gastro.2007.05.010
M3 - Article
C2 - 17631133
AN - SCOPUS:34447105862
SN - 0016-5085
VL - 133
SP - 72
EP - 79
JO - Gastroenterology
JF - Gastroenterology
IS - 1
ER -