Proper management and follow-up strategy of branch duct intraductal papillary mucinous neoplasms of the pancreas.
OBJECTIVE
It has been reported that main duct intraductal papillary mucinous neoplasms are more invasive and have a worse prognosis than branch duct intraductal papillary mucinous neoplasms. Therefore, an aggressive surgical approach has mainly been recommended for all MD-IPMNs. However, the surgical management of BD-IPMNs has been controversial and the consensus guidelines are not specific for an indicator of malignancy in BD-IPMNs. The objective of this study was to determine the proper management and follow-up strategy of BD-IPMNs.


METHODS
We monitored and analysed patients with presumed BD-IPMNs between March 1995 and March 2010.


RESULTS
The mean value of the initial cyst size in all patients with BD-IPMNs was 2.19 cm. Amongst 194 patients with BD-IPMNs, 34 underwent immediate surgical resection, 152 were followed conservatively. Amongst the 152 conservatively managed patients, 18 (11.8%) underwent surgical resection after a median follow-up of 12.7 months (range, 3-48 months). In 132 patients who were managed conservatively without surgery, the mean incremental rate of cyst size growth was 0.0038 cm/month during a median of 30.7 months of follow-up and there were no IPMN-related deaths.


CONCLUSIONS
Amongst patients with BD-IPMNs, about 10% have surgery within approximately 1 year from the time of diagnosis because of the occurrence of new malignant stigmata. Therefore, a conservative approach without surgery and careful follow-up every 3 months or 6 months during the first year after diagnosis can be safely advocated in patients with BD-IPMNs larger than 10mm in size who have no risk factors for malignant IPMNs.
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, South Korea.
Sun Youn
SY
Bae
Kyu Taek
KT
Lee
Jin Hee
JH
Lee
Jong Kyun
JK
Lee
Kwang Hyuck
KH
Lee
Jong Chul
JC
Rhee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D018282:Cystadenocarcinoma, Mucinous / Q000175:diagnosis / Q000601:surgery; D018283:Cystadenocarcinoma, Papillary / Q000175:diagnosis / Q000601:surgery; D018291:Cystadenoma, Mucinous / Q000175:diagnosis / Q000601:surgery; D018292:Cystadenoma, Papillary / Q000175:diagnosis / Q000601:surgery; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis / Q000601:surgery*; D010183:Pancreatic Ducts / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011230:Precancerous Conditions / Q000175:diagnosis / Q000601:surgery*; D057832:Watchful Waiting