Year 2018 / Volume 110 / Number 12
Original
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: clinicopathological features and long-term outcomes following a pancreatectomy

768-774

DOI: 10.17235/reed.2018.5646/2018

Javier Antoñanzas, Javier A. Cienfuegos, Luis Hurtado-Pardo, Pablo Panadero, Alberto Benito, Fernando Pardo, Fernando Rotellar, Pablo Martí-Cruchaga, Gabriel Zozaya, Víctor Valentí, José Luis Hernández Lizoain,

Abstract
Objective: the objective of this study was to analyze the anatomical and clinical features and long-term oncologic outcomes of 25 patients that underwent surgery due to intraductal papillary mucinous neoplasm of the pancreas. Material and methods: patients undergoing surgery for intraductal papillary mucinous neoplasm of the pancreas were identified from a prospective database of pancreatic resections. Demographic data, symptoms, type of surgery and type of lesion (branch type, main duct or mixed) were recorded. The lesions were classified into invasive (high grade dysplasia and carcinoma) and noninvasive (low- or intermediate-grade dysplasia). Postoperative complications were analyzed as well as the pattern of recurrence and disease-free survival at five and ten years. Results: the most common symptoms in the 25 patients (14 males and eleven females) were abdominal pain and weight loss. Eight (32%) cases were diagnosed incidentally. Twelve (48%) of the lesions were of the branch type, three affected the main duct and ten (40%) were mixed. Twelve cephalic duodenopancreatectomies and seven total pancreatectomies were performed; three were central; two, distal; and one, enucleation. Seven cases (32%) had an invasive phenotype. Three patients had locoregional and distant recurrence at six, 16 and 46 months after surgery with a median follow-up of 7.7 years. Disease-free survival at five and ten years for the noninvasive type was 94% and 57% for invasive phenotypes (p < 0.05). Conclusions: intraductal papillary mucinous neoplasm is a heterogeneous entity with well differentiated phenotypes, which requires a tailored strategy and treatment, as established in the current consensus guidelines due to its malignant potential.
Share Button
New comment
Comments
No comments for this article
References
1. Elta GH, Enestvedt BK, Sauer BG et al. ACG Clinical Guideline: Diagnosis and Management of Pancreatic Cysts. Am. J. Gastroenterol. 2018: [Epub ahead of print].
2. Stark A, Donahue TR, Reber HA et al. Pancreatic Cyst Disease: A Review. JAMA 2016; 315: 1882–93.
3. Basturk O, Hong S-M, Wood LD et al. A Revised Classification System and Recommendations From the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas. Am. J. Surg. Pathol. 2015; 39: 1730–41.
4. Moris M, Wallace MB. Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations. Rev. Esp. Enferm. Dig. 2017; 109: 358–367.
5. Tanaka M, Chari S, Adsay V et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 2006; 6: 17–32.
6. Tanaka M, Fernandez-del Castillo C, Adsay V et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatol. Off. J. Int. Assoc. Pancreatol. ...[et al.] 2012; 12: 183–197.
7. Ohashi K, Murakami Y, Takekoshi T. Four cases of “mucin-producing” cancer of the pancreas on specific findings of the papilla of Vater. Prog Dig Endosc 1982; 20: 348–351.
8. European Study Group on Cystic Tumours of the Pancreas. European evidence-based guidelines on pancreatic cystic neoplasms. Gut 2018; 67: 789–804.
9. Adsay V, Mino-Kenudson M, Furukawa T et al. Pathologic Evaluation and Reporting of Intraductal Papillary Mucinous Neoplasms of the Pancreas and Other Tumoral Intraepithelial Neoplasms of Pancreatobiliary Tract: Recommendations of Verona Consensus Meeting. Ann. Surg. 2016; 263: 162–77.
10. Scheiman JM, Hwang JH, Moayyedi P. American gastroenterological association technical review on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology 2015; 148: 824–48.e22.
11. Lennon AM, Manos LL, Hruban RH et al. Role of a multidisciplinary clinic in the management of patients with pancreatic cysts: a single-center cohort study. Ann. Surg. Oncol. 2014; 21: 3668–3674.
12. Kneuertz PJ, Pitt HA, Bilimoria KY et al. Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J. Gastrointest. Surg. 2012; 16: 1727–35.
13. El Gammal AT, Izbicki JR. Incidental Intraductal Papillary Mucinous Neoplasm, Cystic or Premalignant Lesions of the Pancreas: The Case for Aggressive Management. Surg. Clin. North Am. 2018; 98: 141–155.
14. von Elm E, Altman DG, Egger M et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies. Int. J. Surg. 2014; 12: 1495–1499.
15. Adsay N V, Fukushima N, Furukawa T et al. Intraductal neoplasms of the pancreas. In: Bosman FT, Carneiro F, Hruban RH, et al., eds. WHO classification of tumours of the digestive system. 4th ed. Lyon: International Agency for Research on Cancer, 2010, pp.304–313.
16. Goh BK, Lin Z, Tan DM et al. Evaluation of the Fukuoka Consensus Guidelines for intraductal papillary mucinous neoplasms of the pancreas: Results from a systematic review of 1,382 surgically resected patients. Surgery 2015; 158: 1192–1202.
17. Pittman ME, Rao R, Hruban RH. Classification, Morphology, Molecular Pathogenesis, and Outcome of Premalignant Lesions of the Pancreas. Arch. Pathol. Lab. Med. 2017; 141: 1606–1614.
18. New classification of physical status. Anesthesiology 1963; 24: 111.
19. Ogawa H, Itoh S, Ikeda M et al. Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 2008; 248: 876–86.
20. Mukewar S, de Pretis N, Aryal-Khanal A et al. Fukuoka criteria accurately predict risk for adverse outcomes during follow-up of pancreatic cysts presumed to be intraductal papillary mucinous neoplasms. Gut 2017; 66: 1811–1817.
21. Rotellar F, Pardo F, Montiel C et al. Totally laparoscopic Roux-en-Y duct-to-mucosa pancreaticojejunostomy after middle pancreatectomy: a consecutive nine-case series at a single institution. Ann. Surg. 2008; 247: a.
22. Rotellar F, Pardo F, Cervera M et al. Laparoscopic distal pancreatectomy with or without splenectomy. Surgical technique. Surg.Endosc. 2006; 20 Suppl 1: S245.
23. Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg. 2004; 240: 205–13.
24. Bassi C, Dervenis C, Butturini G et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138: 8–13.
25. Wente MN, Veit JA, Bassi C et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142: 20–25.
26. Wente MN, Bassi C, Dervenis C et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142: 761–8.
27. Cienfuegos JA, Benito A, Rotellar F. Agenesis of the dorsal pancreas associated with mucinous cysts and chronic calcific non-alcoholic pancreatitis. Rev. Esp. Enferm. Dig. 2017; 109: 395–396.
28. Lariño Noia J. Latest advances in pancreatic tumours. Gastroenterol. Hepatol. 2016; 39 Suppl 1: 93–101.
29. Basturk O, Adsay V, Askan G et al. Intraductal Tubulopapillary Neoplasm of the Pancreas: A Clinicopathologic and Immunohistochemical Analysis of 33 Cases. Am. J. Surg. Pathol. 2017; 41: 313–325.
30. Fearon ER. Molecular genetics of colorectal cancer. Annu. Rev. Pathol. 2011; 6: 479–507.
31. Maguchi H, Tanno S, Mizuno N et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas 2011; 40: 364–70.
32. Hruban RH, Takaori K, Klimstra DS et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am. J. Surg. Pathol. 2004; 28: 977–87.
33. Tanaka M, Kobayashi K, Mizumoto K et al. Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas. J. Gastroenterol. 2005; 40: 669–75.
34. Sohn TA, Yeo CJ, Cameron JL et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann. Surg. 2001; 234: 313-21–2.
35. Adsay NV, Conlon KC, Zee SY et al. Intraductal papillary-mucinous neoplasms of the pancreas: an analysis of in situ and invasive carcinomas in 28 patients. Cancer 2002; 94: 62–77.
36. Valsangkar NP, Morales-Oyarvide V, Thayer SP et al. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery 2012; 152: S4-12.
37. Schnelldorfer T, Sarr MG, Nagorney DM et al. Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Arch. Surg. 2008; 143: 639–46; discussion 646.
38. Rodriguez JR, Salvia R, Crippa S et al. Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 2007; 133: 72-9-10.
39. Hirono S, Kawai M, Okada KI et al. Factors Associated With Invasive Intraductal Papillary Mucinous Carcinoma of the Pancreas. JAMA Surg. 2017; 152: e165054.
40. Sugimoto M, Elliott IA, Nguyen AH et al. Assessment of a Revised Management Strategy for Patients With Intraductal Papillary Mucinous Neoplasms Involving the Main Pancreatic Duct. JAMA Surg. 2017; 152: e163349.
41. Winter JM, Cameron JL, Campbell KA et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J. Gastrointest. Surg. 2006; 10: 1199–210.
42. Correa-Gallego C, Ferrone CR, Thayer SP et al. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology 2010; 10: 144–50.
43. Crippa S, Pergolini I, Rubini C et al. Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms. Surgery 2016; 159: 1041–9.
44. Laffan TA, Horton KM, Klein AP et al. Prevalence of unsuspected pancreatic cysts on MDCT. AJR. Am. J. Roentgenol. 2008; 191: 802–7.
45. Suzuki R, Thosani N, Annangi S et al. Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: a systematic review and meta-analysis. Pancreatology 2014; 14: 380–4.
46. Sohn TA, Yeo CJ, Cameron JL et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann. Surg. 2004; 239: 788-97–9.
47. Tanno S, Nakano Y, Koizumi K et al. Pancreatic ductal adenocarcinomas in long-term follow-up patients with branch duct intraductal papillary mucinous neoplasms. Pancreas 2010; 39: 36–40.
48. Tamura K, Ohtsuka T, Ideno N et al. Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: a retrospective review. Ann. Surg. 2014; 259: 360–8.
Related articles
Citation tools
Antoñanzas J, A. Cienfuegos J, Hurtado-Pardo L, Panadero P, Benito A, Pardo F, et all. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: clinicopathological features and long-term outcomes following a pancreatectomy. 5646/2018


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 1397 visits.
This article has been downloaded 236 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 11/04/2018

Accepted: 11/06/2018

Online First: 28/08/2018

Published: 03/12/2018

Article revision time: 56 days

Article Online First time: 139 days

Article editing time: 236 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology