Clinical fate of branch duct and mixed forms of intraductal papillary mucinous neoplasia of the pancreas.
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.
Bournet
Barbara
B
Department of Gastroenterology, Centres Hospitaliers Universitaires Rangueil-Larrey and Purpan, Paul Sabatier University, Toulouse, France.
Kirzin
Sylvain
S
Carrère
Nicolas
N
Portier
Guillaume
G
Otal
Philippe
P
Selves
Janick
J
Musso
Carole
C
Suc
Bertrand
B
Moreau
Jacques
J
Fourtanier
Gilles
G
Pradère
Bernard
B
Lazorthes
Franck
F
Escourrou
Jean
J
Buscail
Louis
L
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