Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas.
OBJECTIVE
The predictors of malignant intraductal papillary mucinous neoplasm (IPMN) and invasive IPMN were investigated in this study to determine the optimal indicators of surgical resection for IPMN.


BACKGROUND
Recently, international consensus guidelines have described the standard indicators of resection for IPMN. However, the indicators of surgical resection for IPMN, especially for branch duct IPMN, still remain controversial.


METHODS
Eighty-two patients with IPMN who underwent surgical resection during April 1998 to January 2009, were retrospectively reviewed and examined with regard to their preoperative factors and pathologic diagnosis.


RESULTS
Multivariate analysis showed that main duct IPMN (P<0.01) and earlier diabetes (P=0.03) were independent predictors of malignant IPMN. In branch duct IPMN, the diameter of the main pancreatic duct (MPD) was found to be significantly associated with malignancy by univariate analysis (P=0.034). An elevated serum CA19-9 level (P<0.01) was an independent predictor of invasive IPMN.


CONCLUSIONS
Our observations suggest that main duct IPMN, branch duct IPMN with MPD dilatation, and IPMN with an elevated serum CA19-9 level should be considered as indications for surgical resection.
Mimura
Takuya
T
Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Masuda
Atsuhiro
A
Matsumoto
Ippei
I
Shiomi
Hideyuki
H
Yoshida
Shiei
S
Sugimoto
Maki
M
Sanuki
Tsuyoshi
T
Yoshida
Masaru
M
Fujita
Tsuyoshi
T
Kutsumi
Hiromu
H
Ku
Yonsou
Y
Azuma
Takeshi
T
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D032921:Consensus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D018395:CA-19-9 Antigen