title: Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation.
abstract: BACKGROUND
  Intraductal papillary mucinous neoplasms (IPMN) may represent a field defect of pancreatic ductal instability. The relative risk of carcinoma in regions remote from the radiographically identified cyst remains poorly defined. This study describes the natural history of IPMN in patients initially selected for resection or surveillance.
  
  
  METHODS
  Patients with IPMN submitted to resection or radiographic surveillance were identified from a prospectively maintained database. Comparisons were made between these two groups.
  
  
  RESULTS
  From 1995 to 2010, a total of 356 of 1,425 patients evaluated for pancreatic cysts fulfilled inclusion criteria. Median follow-up for the entire cohort was 36 months. Initial resection was selected for 186 patients (52 %); 114 had noninvasive lesions and 72 had invasive disease. A total of 170 patients underwent initial nonoperative management. Median follow-up for this surveillance group was 40 months. Ninety-seven patients (57 % of those under surveillance) ultimately underwent resection, with noninvasive disease in 79 patients and invasive disease in 18. Five of the 18 (28 %) invasive lesions developed in a region remote from the monitored lesion. Ninety invasive carcinomas were identified in the entire population (25 %), ten of which developed the invasive lesion separate from the index cyst, representing 11 % with invasive disease.
  
  
  CONCLUSIONS
  Invasive disease was identified in 39 % of patients with IPMN selected for initial resection and 11 % of patients selected for initial surveillance. Ten patients developed carcinoma in a region separate from the radiographically identified IPMN, representing 2.8 % of the study population. Diagnostic, operative, and surveillance strategies for IPMN should consider risk not only to the index cyst but also to the entire gland.
authors.affiliation: Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lafemina
authors.forename: N
authors.initials: N
authors.lastname: Katabi
authors.forename: D
authors.initials: D
authors.lastname: Klimstra
authors.forename: C
authors.initials: C
authors.lastname: Correa-Gallego
authors.forename: S
authors.initials: S
authors.lastname: Gaujoux
authors.forename: T P
authors.initials: TP
authors.lastname: Kingham
authors.forename: R P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Y
authors.initials: Y
authors.lastname: Fong
authors.forename: M I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: W R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: R K
authors.initials: RK
authors.lastname: Do
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate