Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?

详细信息    查看全文

• 作者：Jin-Young Jang MD ; PhD (1)
  Sun-Whe Kim MD ; PhD (1)
  Seung Eun Lee MD (1)
  Sung Hoon Yang MD (1)
  Kuhn Uk Lee MD ; PhD (1)
  Young Joo Lee MD ; PhD (2)
  Song Chul Kim MD ; PhD (2)
  Duck Jong Han MD ; PhD (2)
  Dong Wook Choi MD ; PhD (3)
  Seong Ho Choi MD ; PhD (3)
  Jin Seok Heo MD ; PhD (3)
  Baik Hwan Cho MD ; PhD (4)
  Hee Chul Yu MD ; PhD (4)
  Dong Sup Yoon MD ; PhD (5)
  Woo Jung Lee MD ; PhD (5)
  Hee-Eun Lee MD (6)
  Gyeong Hoon Kang MD ; PhD (6)
  Jeong Min Lee MD ; PhD (7)
  
• 关键词：Intraductal papillary mucinous neoplasm ; Branch duct ; Size ; Mural nodule
• 刊名：Annals of Surgical Oncology
• 出版年：2008
• 出版时间：January 2008
• 年：2008
• 卷：15
• 期：1
• 页码：199-205
• 全文大小：240KB
• 参考文献：1. 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;447:794- CrossRef
  2. Longnecker DS, Adsay NV, Fernandez-del Castillo C, et al. Histopathological diagnosis of pancreatic intraepithelial neoplasia and intraductal papillary-mucinous neoplasms: interobserver agreement. Pancreas 2005;31:344- CrossRef
  3. Tanaka M, Chari S, Adsay V, et al. International Association of Pancreatology. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006;6:17-2 CrossRef
  4. Jang JY, Kim SW, Ahn YJ, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol 2005;12:124-2 CrossRef
  5. Levy P, Jouannaud V, O’Toole D, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol 2006;4:460- CrossRef
  6. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas. An updated experience. Ann Surg 2004;239:788-9 CrossRef
  7. 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 2006;56:1086-0 CrossRef
  8. Bassi C, Falconi M, Salvia R, et al. The spectrum of intraductal tumors. In: Dernenis CG, Bassi C, eds. Pancreatic Tumors. Stuttgart: Georg Thieme Verlag, 2000:289-03
  9. Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y. Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 2003;90:1244- CrossRef
  10. Shima Y, Mori M, Takakura N, Kimura T, Yagi T, Tanaka N. Diagnosis and management of cystic pancreatic tumours with mucin production. Br J Surg 2000;87:1041- CrossRef
  11. Bernard P, Scoazec JY, Joubert M, et al. Intraductal papillary mucinous tumors of the pancreas: predictive criteria of malignancy according to pathological examination of 53 cases. Arch Surg 2002;137:1274- CrossRef
  12. Spinelli KS, Fromwiller TE, Daniel RA, et al. Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004;239:651- CrossRef
  13. 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;34:457-2 CrossRef
  14. Stelow EB, Stanley MW, Bardales RH, et al. Intraductal papillary-mucinous neoplasm of the pancreas. The findings and limitations of cytologic samples obtained by endoscopic ultrasound-guided fine-needle aspiration. Am J Clin Pathol 2003;120:398-04 CrossRef
  15. 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;40:856-2 CrossRef
  16. Carbognin G, Zamboni G, Pinali L, Chiara ED, Girardi V, Salvia R, Mucelli RP. Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up. Abdom Imaging 2006;31:320- CrossRef
  17. Irie H, Yoshimitsu K, Aibe H, et al. Natural history of pancreatic intraductal papillary mucinous tumor of branch duct type: follow-up study by magnetic resonance cholangiopancreatography. J Comput Assist Tomogr 2004;28:117-2 CrossRef
  18. Sai JK, Suyama M, Kubokawa Y, et al. Management of branch duct-type intraductal papillary mucinous tumor of the pancreas based on magnetic resonance imaging. Abdom Imaging 2003;28:694- CrossRef
  19. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg 2002;236:355-6 CrossRef
  
• 作者单位：Jin-Young Jang MD, PhD (1)
  Sun-Whe Kim MD, PhD (1)
  Seung Eun Lee MD (1)
  Sung Hoon Yang MD (1)
  Kuhn Uk Lee MD, PhD (1)
  Young Joo Lee MD, PhD (2)
  Song Chul Kim MD, PhD (2)
  Duck Jong Han MD, PhD (2)
  Dong Wook Choi MD, PhD (3)
  Seong Ho Choi MD, PhD (3)
  Jin Seok Heo MD, PhD (3)
  Baik Hwan Cho MD, PhD (4)
  Hee Chul Yu MD, PhD (4)
  Dong Sup Yoon MD, PhD (5)
  Woo Jung Lee MD, PhD (5)
  Hee-Eun Lee MD (6)
  Gyeong Hoon Kang MD, PhD (6)
  Jeong Min Lee MD, PhD (7)
  
  1. Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, South Korea
  2. Department of Surgery, Ulsan University College of Medicine, 388-1, Pungnap-2 dong, songpa-gu, Seoul, South Korea
  3. Department of Surgery, Sungkyunkwan University School of Medicine, Ilwon-don Kangnam-gu, Seoul, South Korea
  4. Department of Surgery, Chonbuk National University College of Medicine, Jeonju-si, Dukjin-gu, Chonbuk, South Korea
  5. Department of Surgery, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, South Korea
  6. Department of Pathology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, South Korea
  7. Department of Radiology, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, South Korea
  

文摘

Background The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to surgery or observation) has been issued on the management of branch duct type IPMN. Methods We retrospectively reviewed the clinicopathological data of 138 patients who underwent operations for IPMN between 1993 and 2006 at five institutes in Korea. Results Of 138 patients (mean age, 60.6 years; 87 men, 51 women), 76 underwent pancreatoduodenectomy, 39 distal pancreatectomy, 4 total pancreatectomy, and 20 limited pancreatic resection. There were 112 benign cases: 47 adenoma, 63 borderline cases, and 26 malignant cases, with 9 of these being noninvasive and 17 invasive. By univariate analysis, tumor size and the presence of a mural nodule were identified as meaningful predictors of malignancy. By receiver operating characteristic curve analysis, a tumor size of >2 cm was found to be the most valuable predictor of malignancy. When cases were classified according to tumor size and the presence of a mural nodule, the malignancy rate for a tumor ? cm without a mural nodule was 9.2%, for a tumor of ? cm plus a mural nodule was 25%, and for other conditions such as tumor >2 cm, >25%. Conclusions Many branch duct IPMNs are malignant. Surgical treatment is recommended, except in cases that are strongly suspected to be benign or cases that present a high operative risk. Observation is only recommended in patients with a tumor size of ? cm without a mural nodule.