Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe?
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 </=2 cm without a mural nodule was 9.2%, for a tumor of </=2 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 </=2 cm without a mural nodule.
Jang
Jin-Young
JY
Department of Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul, South Korea. sunkim@plaza.snu.ac.kr
Kim
Sun-Whe
SW
Lee
Seung Eun
SE
Yang
Sung Hoon
SH
Lee
Kuhn Uk
KU
Lee
Young Joo
YJ
Kim
Song Chul
SC
Han
Duck Jong
DJ
Choi
Dong Wook
DW
Choi
Seong Ho
SH
Heo
Jin Seok
JS
Cho
Baik Hwan
BH
Yu
Hee Chul
HC
Yoon
Dong Sup
DS
Lee
Woo Jung
WJ
Lee
Hee-Eun
HE
Kang
Gyeong Hoon
GH
Lee
Jeong Min
JM
D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D000236:Adenoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate