title: Management of pancreatic intraductal papillary mucinous neoplasm in an academic hospital (2005-2010): what follow-up for unoperated patients?
abstract: OBJECTIVE
  Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are diagnosed frequently in asymptomatic patients. It is still not clear what follow-up is indicated for patients not undergoing surgical resection.
  
  
  METHODS
  Review of all reports of magnetic resonance cholangiopancreatography (MRCP) from June 2005 to June 2010, identifying all patients diagnosed with IPMN; subsequent reconstruction of the initial therapeutic decision, indications for and adherence to scheduled follow-up, and IPMN evolution by morphology and by biology.
  
  
  RESULTS
  Overall, 4943 MRCP reports were analyzed, identifying 234 patients with IPMN. Although 143 (61.1%) of these were comprised in Sendai criteria for resection, surgical resection was considered in only 42 (17.9%) patients. Of the remainder, 52 were not subjected to any control, 58 to a single short time check, 77 to MRCP-based regular annual follow-up, and 5 were treated for associated ductal adenocarcinoma. With a median follow-up of 39.5 months (range, 12-72), 37.6% of 125 patients in follow-up had a morphological evolution, but only 2.4% has developed a malignant IPMN. No deaths were recorded, directly related to IPMN, in all 187 conservatively managed patients.
  
  
  CONCLUSIONS
  In the analyzed series, fewer patients than expected underwent surgical resection, and only 67.2% undergo regular follow-up, but no more than 2.4% developed malignancy.
authors.affiliation: Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, Italy. baiocchi@med.unibs.it
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Baiocchi
authors.forename: Nazario
authors.initials: N
authors.lastname: Portolani
authors.forename: Luigi
authors.initials: L
authors.lastname: Grazioli
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Mazza
authors.forename: Federico
authors.initials: F
authors.lastname: Gheza
authors.forename: Michele
authors.initials: M
authors.lastname: Bartoli
authors.forename: Enrico
authors.initials: E
authors.lastname: Vanzetti
authors.forename: Stefano M
authors.initials: SM
authors.lastname: Giulini
mesh_terms: D000046:Academic Medical Centers; D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000601:surgery; D049448:Cholangiopancreatography, Magnetic Resonance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery; D012189:Retrospective Studies; D057832:Watchful Waiting