title: Clinical fate of branch duct and mixed forms of intraductal papillary mucinous neoplasia of the pancreas.
abstract: OBJECTIVE
  The aim of the present study was to assess the clinical fate of, and to gain new insights into, branch duct and mixed (predominantly main duct type) forms of intraductal papillary mucinous neoplasia of the pancreas (IPMN).
  
  
  METHODS
  During a 17-year period, 99 successive IPMN patients (52 men, 47 women; mean age, 64 years) were included and divided into two groups for further comparison: one group had branch duct IPMN, whereas the other had mixed IPMN.
  
  
  RESULTS
  Patients from the mixed IPMN group (n = 52) displayed a greater rate of symptoms (83% vs 55%, P = 0.004), pancreatic resection (67% vs 38%, P = 0.007), malignancy (35% vs 13%, P = 0.017) and death (15% vs 4%, P = 0.09) than those from the branch duct IPMN group. A 38-month follow up of non-operated, symptom-free patients confirmed that more than 85% of branch duct IPMN patients were asymptomatic without evidence of malignancy. Borderline lesions and carcinoma are found in up to 50% of symptomatic resected branch duct IPMN cases.
  
  
  CONCLUSIONS
  Patients with the mixed form of IPMN as well as with symptomatic branch duct IPMN should require pancreatic resection because of symptoms and the risk for malignancy. In silent branch duct IPMN without radiological signs of malignancy, a non-operative watch-and-wait strategy can be discussed.
authors.affiliation: Department of Gastroenterology, Centres Hospitaliers Universitaires Rangueil-Larrey and Purpan, Paul Sabatier University, Toulouse, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bournet
authors.forename: Sylvain
authors.initials: S
authors.lastname: Kirzin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrère
authors.forename: Guillaume
authors.initials: G
authors.lastname: Portier
authors.forename: Philippe
authors.initials: P
authors.lastname: Otal
authors.forename: Janick
authors.initials: J
authors.lastname: Selves
authors.forename: Carole
authors.initials: C
authors.lastname: Musso
authors.forename: Bertrand
authors.initials: B
authors.lastname: Suc
authors.forename: Jacques
authors.initials: J
authors.lastname: Moreau
authors.forename: Gilles
authors.initials: G
authors.lastname: Fourtanier
authors.forename: Bernard
authors.initials: B
authors.lastname: Pradère
authors.forename: Franck
authors.initials: F
authors.lastname: Lazorthes
authors.forename: Jean
authors.initials: J
authors.lastname: Escourrou
authors.forename: Louis
authors.initials: L
authors.lastname: Buscail
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003537:Cystadenoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome