Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate?
BACKGROUND
Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas are reported to be less aggressive than the main-duct type. Hence, less aggressive treatment has been proposed for the former.


OBJECTIVE
To evaluate the effectiveness of a follow-up protocol for BD-IPMNs.


METHODS
Prospective study.


METHODS
An academic tertiary referral centre.


METHODS
From 2000 to 2003, 109 patients with BD-IPMNs underwent trans-abdominal ultrasound and magnetic resonance cholangiopancreatography with secretin. Patients who presented malignancy-related parameters (size >3.5 cm, nodules, thick walls, carbohydrate antigen 19.9 level >25 U/l, recent-onset or worsened diabetes) and/or complained of symptoms were submitted to surgery (arm A). All asymptomatic patients without suspicion of malignancy were followed up according to a 6-month clinical-radiological protocol (arm B).


METHODS
The effectiveness of conservative management of BD-IPMNs.


RESULTS
20 (18.3%) patients underwent surgery (arm A); pathological diagnosis of BD-IPMNs was always confirmed. 89 (81.7%) patients were followed up for a median of 32 months (arm B); of these, 57 (64%) patients had multifocal disease. After a mean follow-up of 18.2 months, 5 (5.6%) patients showed an increase in lesion size and underwent surgery. The pathological diagnosis was branch-duct adenoma in three patients and borderline adenoma in two.


CONCLUSIONS
Surgery is indicated in <20% of cases of BD-IPMNs, and, in the absence of malignancy-related parameters, careful non-operative management seems to be safe and effective in asymptomatic patients. Although observation for a longer time is needed to confirm these results, our findings support the guidelines recently recommended by the International Association of Pancreatology.
Salvia
Roberto
R
Department of Surgery, University of Verona, Policlinico GB Rossi, Piazzale LA Scuro 10, 37134 Verona, Italy.
Crippa
Stefano
S
Falconi
Massimo
M
Bassi
Claudio
C
Guarise
Alessandro
A
Scarpa
Aldo
A
Pederzoli
Paolo
P
D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000231:Adenocarcinoma, Papillary / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D015295:Antigens, Tumor-Associated, Carbohydrate