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Surgical Outcome of Intraductal Papillary Mucinous Neoplasms of the
Pancreas.Ann
Surg Oncol. 2007 Aug 12;
OBJECTIVE: An
increasing number of intraductal papillary mucinous neoplasms of the
pancreas have been reported in recent years. However, the
clinicopathologic features and surgical outcome of this neoplasm are
not fully understood because of the limited number of cases. The
objective of this study is to clarify the clinicopathologic features
of intraductal papillary mucinous neoplasm of the pancreas and
evaluate prognostic factors influencing survival. METHODS: Eighty-two
patients with intraductal papillary mucinous neoplasm undergoing
surgical resection at the National Cancer Center Hospital East between
April 1994 and October 2006 were retrospectively analyzed. RESULTS:
There were 31 patients with adenoma and 51 patients with carcinoma.
Carcinomas were subdivided into noninvasive carcinoma (n = 14),
minimally invasive carcinoma (n = 6), and invasive carcinoma (n = 31).
The postoperative mortality rate was 0%. The 5-year survival rate for
patients with intraductal papillary mucinous adenoma, noninvasive
carcinoma, minimally invasive carcinoma, and invasive carcinoma was
80%, 78%, 83%, and 24%, respectively. Regardless of the margin status,
no patient with adenoma developed recurrent disease. There were
significant differences in survival between noninvasive carcinoma and
invasive carcinoma (P = .016) and between minimally invasive carcinoma
and invasive carcinoma (P = .030). Multivariate analysis confirmed
that lymph node metastasis (P = .004) and age (P = .015) were
significant prognostic factors after surgical resection of these
neoplasms. CONCLUSIONS: Patients with intraductal papillary mucinous
adenoma, noninvasive carcinoma, and minimally invasive carcinoma
showed favorable survival. In contrast, invasive intraductal papillary
mucinous carcinoma was associated with poor survival regardless of the
margin status. Nodal involvement was the strongest predictor of poor
survival.
Proposed new
score predicting malignancy of intraductal papillary mucinous
neoplasms of the pancreas.Am
J Surg. 2007 Sep;194(3):304-7.
BACKGROUND: Our
objective was to predict malignancy for intraductal papillary mucinous
neoplasms of the pancreas (IPMN) before operation. METHODS: Sixty-four
resected patients with IPMN were examined and 17 parameters were
investigated for their relation to malignancy by univariate and
multivariate analysis. RESULTS: Multivariate logistic regression
analysis showed that IPMN type, the size of main pancreatic duct, and
serum carbohydrate antigen 19-9 were significant for malignancy. Size
of the main pancreatic duct > or = 6.5 mm and serum carbohydrate
antigen 19-9 > or = 35 U/mL scored 3 points, main duct type scored 2
points, and patulous papilla, jaundice, diabetes mellitus, and tumor
size > or = 42 mm scored 1 point. When IPMNs with 3 and more than 3
points using the new score were diagnosed as malignant, accuracy was
90.6%. CONCLUSION: This scoring system for IPMN is feasible to detect
malignancy and useful for selecting an appropriate treatment.
Intraductal papillary mucinous neoplasms of the pancreas: an updated
experience. Ann Surg. 2004
Jun;239(6):788-97.
OBJECTIVE: To
update the authors' experience with intraductal papillary mucinous
neoplasms (IPMNs) of the pancreas. BACKGROUND DATA: IPMNs are
intraductal mucin-producing cystic neoplasms of the pancreas with
clear malignant potential. Since the authors' 2001 report, the number
of IPMNs resected at our institution has more than doubled, providing
an opportunity to define the clinical features of this distinct
neoplasm. METHODS: All patients undergoing pancreatic resection for an
IPMN at the Johns Hopkins Hospital between January 1987 and March 2003
were evaluated. Noninvasive IPMNs were classified as "adenoma,"
"borderline," or "carcinoma-in situ" (CIS) depending on the degree of
dysplasia within the specimen. Invasive cancers were classified as
tubular, colloid, mixed, or anaplastic types. Pathology was
retrospectively reviewed to identify main-duct or branch-duct origin
of the tumors. Long-term overall survival for patients having IPMNs
with invasive cancer was compared with those patients having IPMNs
without an invasive component. RESULTS: Between January 1987 and March
2003, inclusive, 136 pancreatic resections were performed for patients
with IPMNs, with 78 resections performed since January 2001. The mean
age of the patients was 66.8 +/- 1.1 years, with 57% being male and
89% white. Pancreaticoduodenectomy was performed in 71% of patients,
total pancreatectomy in 15%, distal pancreatectomy in 12%, and central
pancreatic resection in 2%. IPMNs without evidence of invasive cancer
were identified in 62% (n = 84) of patients (17% adenoma, 28%
borderline, or 55% CIS). The remaining 38% (n = 52) of patients had
IPMNs with associated invasive cancer (60% tubular, 27% colloid, 7%
mixed, and 6% anaplastic). The mean age of patients with IPMN adenoma
was 63.2 years, 66.7 years for those with borderline/CIS IPMNs, and
68.1 years for those with invasive cancer (P = 0.08, adenomas vs.
invasive cancer). In those patients with invasive cancers, 15% had
invasive cancer at the final surgical margin, 23% had IPMN without
invasive cancer at the margin, and 54% had lymph node metastases.
Residual IPMN was identified at the neck or uncinate margin in 24% of
patients with noninvasive IPMNs. The overall 5-year survival for
patients having IPMNs without invasive cancer was 77% (several deaths
secondary to metachronous invasive cancer), compared with 43% in those
patients with an invasive component (P < 0.0001). There were no
differences in survival when comparing adenomas, borderline neoplasms,
and CIS. Similarly, there were no statistically significant
differences in survival when comparing branch-duct, main-duct, and
combined variants; however, the branch-duct variants were more often
noninvasive. For those patients with invasive IPMNs, 2-year survival
was 40% when margins were positive for invasive cancer or for IPMN
without invasive cancer, and 60% when margins were tumor-free (P =
0.15). Those patients with colloid carcinomas (n = 14) had improved
survival compared with those with tubular carcinomas (n = 31), with
5-year survival rates of 83% and 24%, respectively. IPMN recurrences
and deaths from cancer occurred in patients with both invasive and
noninvasive IPMNs at initial resection. CONCLUSIONS: IPMNs continue to
be recognized with increasing frequency. Five-year survival for those
patients following resection of IPMNs with invasive cancer (43%) is
improved compared with those patients with resected pancreatic ductal
adenocarcinoma in the absence of IPMN (averages 15%-25%). Survival
following resection of IPMNs without invasive cancer (regardless of
degree of dyplasia) is good, but recurrent disease in the residual
pancreas suggests that long-term surveillance is critical. Based on
the age at resection data, there appears to be a 5-year lag time from
IPMN adenoma (63.2 years) to invasive cancer (68.1 years).
Invasive carcinoma
derived from intraductal papillary mucinous carcinoma of the pancreas.Hepatogastroenterology.
2004 Sep-Oct; 51 (59) : 1480-3.
BACKGROUND/AIMS: Most patients with intraductal papillary mucinous
tumors of the pancreas have a favorable prognosis after surgical
treatment. However, recurrent disease frequently occurs in patients
with invasive carcinoma derived from intraductal papillary mucinous
carcinoma. The objective of this study was to clarify the
clinicopathological features of invasive carcinoma derived from
intraductal papillary mucinous carcinoma. METHODOLOGY: We performed a
retrospective review of the 29 patients with intraductal papillary
mucinous tumor including 10 patients with invasive carcinoma who
underwent pancreatic resection between June 1995 and December 2001 at
the National Cancer Center Hospital East. RESULTS: Of 10 patients with
invasive carcinoma derived from intraductal papillary mucinous
carcinoma, 7 patients had lymph node involvement and 8 patients had
retroperitoneal invasion. The overall 1-, 2-, 4-year actuarial
survival rate for invasive carcinoma derived from intraductal
papillary mucinous carcinoma was 39%, 26%, 13%. Recurrence occurred as
liver metastasis in 3 patients, carcinomatous peritonitis in 3, local
recurrence in 3, and lung metastasis in 1. All patients with adenoma,
non-invasive carcinoma, and minimally invasive carcinoma are alive
without recurrent disease after pancreatic resection. CONCLUSIONS:
Patients with invasive carcinoma derived from intraductal papillary
mucinous carcinoma had a worse prognosis. Margin-negative pancreatic
resection is essential for treating this disease.
Intraductal
papillary or mucinous tumors (IPMT) of the pancreas: report of a case
series and review of the literature.Am
J Gastroenterol. 2001 May;96 (5):1441-7.
OBJECTIVE:
Despite a better understanding of these conditions, intraductal
papillary or mucinous tumors (IPMT) of the pancreas still present
difficulty relating to the predictive factors of malignancy and the
risk of relapse after surgical resection. The aim of this study was to
report on our experience and to compare it to previously published
cases. METHODS: We studied retrospectively 26 patients (mean age 60.3
yr) presenting with IPMT. Of the 26 patients, 19 had surgical
resection and seven did not. The main clinical feature was acute
pancreatitis occurring in 38% of the patients. Segmental
pancreatectomy was performed in all the cases. At pathological
assessment of resection margins, tumor resection was considered as
complete in 17 cases. Margins exhibited benign mucinous involvement,
and resection was considered to be incomplete in one multifocal case
and in one case with diffuse spread of the tumor. RESULTS: A total of
11 tumors were benign and five were malignant. Carcinomas were
invasive in four cases (two invading the pancreatic parenchyma, one
the duodenum, and one the peripancreatic nodes) and in situ in one
case. Malignancy was not diagnosed preoperatively except when invasion
was evident (duodenal spread). Although main pancreatic duct type and
obstructive jaundice appeared as suggestive features for the risk of
malignancy, no reliable preoperative predictive factors for malignancy
could be identified as regarding to clinical parameters, biological
examinations, carcinoembryonic antigen or CA19-9 levels in serum or in
pure pancreatic juice, imaging, and cytological methods. Within 40.8
months mean follow-up after surgery (range 2-96 months), three
patients (16%), two with malignant and one with benign tumor, had
tumor relapse after respectively 7, 27, and 14 months. Margins were
positive without malignant features in the two malignant cases and
negative in the other case. Tumor relapse was malignant with diffuse
spreading in the three cases, and the patients died within 34 months
after surgical resection. CONCLUSIONS: Our series and the review of
the literature indicate that preoperative indicators of malignancy in
IPMT are still lacking. Concerning resection margins, complete tumor
resection is usually possible by segmental pancreatectomy. Malignant
relapses are not exceptional. Incomplete resection and diffuse or
multifocal tumor represent poor prognostic factors. Total
pancreatectomy should be considered in such cases.
Clinicopathological
features and treatment of intraductal papillary mucinous tumour of the
pancreas. Br J Surg.
2001 Mar;88(3):376-81.
BACKGROUND:
The surgical strategy in patients with a pancreatic intraductal
papillary mucinous tumour (IPMT) is still controversial. In this study
the pathological findings in a series of patients were used to
rationalize surgical choice. METHODS: Fifty-one patients with IPMT
were observed between 1988 and 1998 and treated by pancreatic
resection. Factors evaluated included symptoms, tumour site, type of
operation, histological findings and resection margins, tumour stage,
follow-up and survival. RESULTS: Pancreaticoduodenectomy was the most
frequent surgical treatment (33 patients; 65 per cent), followed by
left pancreatectomy (ten), total pancreatectomy (five) and middle
pancreatectomy (three). Histological assessment revealed the tumour to
be an adenoma in 13 patients (25 per cent), a borderline tumour in ten
(20 per cent) and a carcinoma in 28 (55 per cent), 19 of which were
invasive. Mild to moderate dysplasia was present at the resection
margin in 20 specimens (41 per cent), and carcinoma in one. Local
recurrence was observed in four patients (8 per cent), all of whom
underwent a second resection. The 3-year actuarial survival rate for
benign and malignant disease was 94 and 69 per cent respectively (P =
0.03). CONCLUSION: These results suggest that resection should be the
treatment for IPMT. Management of the resection margin could be
crucial in avoiding tumour recurrence.
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