title: Outcomes of primary surveillance for intraductal papillary mucinous neoplasm.
abstract: BACKGROUND
  Limited data are available regarding the natural history of patients undergoing primary surveillance for intraductal papillary mucinous neoplasm (IPMN). We hypothesize that symptoms, radiologic characteristics, and cytopathology will predict cancer risk during surveillance.
  
  
  METHODS
  Between March 2002 and March 2010, 522 patients were diagnosed with IPMN at a single, high-volume institution. Low versus high oncologic risk was stratified prospectively. Patients with under 3 months of surveillance were excluded.
  
  
  RESULTS
  Two hundred ninety-two patients underwent primary surveillance for IPMN. Two hundred forty-four (84%) were classified as low-risk IPMN. Mean surveillance duration was 35 (4-99) months. Thirty (12%) patients initially stratified as low-risk developed a new indication for pancreatic resection. Only 28 underwent resection, and pathologic tissue analysis revealed 27 (96%) low-grade IPMN and one (4%) high-grade dysplastic IPMN. Overall, two (1%) patients initially determined to be low-risk developed invasive cancer. Forty-eight (16%) patients stratified as high-risk IPMN were initially managed nonoperatively. Of the 13 (27%) high-risk patients that died during follow-up, two (15%) died from pancreatic cancer.
  
  
  CONCLUSIONS
  Progression to pancreatic cancer during surveillance for low-risk IPMN was rare. Current indications for resection did not forecast malignancy. Poor operative candidates with high-risk IPMN progressed to invasive cancer more commonly, though a substantial portion succumbed to non-IPMN-related death.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
authors.forename: Christy E
authors.initials: CE
authors.lastname: Cauley
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Waters
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Dumas
authors.forename: Juliana E
authors.initials: JE
authors.lastname: Meyer
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Al-Haddad
authors.forename: John M
authors.initials: JM
authors.lastname: DeWitt
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D018450:Disease Progression; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000473:pathology* / Q000601:surgery; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D011159:Population Surveillance; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk
references.citation: J Gastrointest Surg. 2008 Mar;12(3):414-6
references.pmid: 17968632
references.citation: J Am Coll Surg. 2007 May;204(5):987-93; discussion 993-5
references.pmid: 17481526
references.citation: Gastroenterology. 2007 Jul;133(1):72-9; quiz 309-10
references.pmid: 17631133
references.citation: Adv Surg. 2008;42:87-108
references.pmid: 18953811
references.citation: Ann Surg. 2004 Jun;239(6):788-97; discussion 797-9
references.pmid: 15166958
references.citation: Ann Surg. 2007 Oct;246(4):644-51; discussion 651-4
references.pmid: 17893501
references.citation: Arch Surg. 2002 Nov;137(11):1274-8
references.pmid: 12413317
references.citation: Pancreatology. 2006;6(1-2):17-32
references.pmid: 16327281
references.citation: J Gastrointest Surg. 2008 Apr;12(4):645-50
references.pmid: 18097728
references.citation: J Gastrointest Surg. 2008 Jan;12(1):101-9
references.pmid: 17917784
references.citation: Ann Surg Oncol. 2006 Apr;13(4):582-94
references.pmid: 16523362
references.citation: J Gastrointest Surg. 2003 Mar-Apr;7(3):417-28
references.pmid: 12654569
references.citation: Ann Surg. 2004 Mar;239(3):400-8
references.pmid: 15075659
references.citation: Am J Surg Pathol. 2004 Aug;28(8):977-87
references.pmid: 15252303
references.citation: World J Surg. 1998 Aug;22(8):874-8
references.pmid: 9673562
references.citation: Endoscopy. 2010 Dec;42(12):1077-84
references.pmid: 21120776
references.citation: Am J Gastroenterol. 2007 Aug;102(8):1759-64
references.pmid: 17686073
references.citation: Arch Surg. 2003 Jun;138(6):610-7; discussion 617-8
references.pmid: 12799331
references.citation: Ann Surg. 2001 Sep;234(3):313-21; discussion 321-2
references.pmid: 11524584
references.citation: Gut. 2007 Aug;56(8):1086-90
references.pmid: 17127707
references.citation: J Surg Oncol. 2006 Aug 1;94(2):91-3
references.pmid: 16847916
references.citation: Eur J Surg Oncol. 2007 Aug;33(6):678-84
references.pmid: 17207960
references.citation: Ann Surg. 2004 May;239(5):651-7; discussion 657-9
references.pmid: 15082969
references.citation: Ann Surg. 2004 May;239(5):678-85; discussion 685-7
references.pmid: 15082972
references.citation: Am J Gastroenterol. 1999 Feb;94(2):470-3
references.pmid: 10022648
references.citation: Ann Surg Oncol. 2011 Jan;18(1):199-206
references.pmid: 20717734