title: Outcomes of intraductal papillary mucinous neoplasm with "Sendai-positive" criteria for resection undergoing non-operative management.
abstract: BACKGROUND
  There are few data on the outcome of patients with intraductal papillary mucinous neoplasms of the pancreas meeting criteria for resection (Sendai-positive), and not operated.
  
  
  OBJECTIVE
  To evaluate outcome of patients with a resectable, Sendai-positive intraductal papillary mucinous neoplasm, and not operated.
  
  
  METHODS
  Multicentre, retrospective analysis of prospectively enrolled patients, with resectable Sendai-positive, not-operated intraductal papillary mucinous neoplasm. Overall-survival and disease-specific survival were the primary end-point, and progression-free survival secondary.
  
  
  RESULTS
  Thirty-five patients (60% male, median age 77) enrolled: 40% main-duct, 60% branch-duct intraductal papillary mucinous neoplasms. In 19 patients surgery was ruled out due to comorbidities, in 7 because aged > 80, 9 refused surgery. Twelve (34.3%) patients died after a mean of 32.5 months, 8 due to disease progression, 4 due to comorbidities. The median overall, disease-specific and progression-free survival were 52, 55, and 44 months respectively. Main duct involvement and age at diagnosis were associated with worse overall and progression-free survival, only main duct involvement with worse disease-specific survival (52 months main duct vs. 64 branch duct; P = 0.04).
  
  
  CONCLUSIONS
  These results suggest that in elderly and comorbid patients with Sendai-positive intraductal papillary mucinous neoplasms, especially of the branch duct, a conservative approach could be reasonable, as associated with a relatively good outcome, and should be carefully discussed with the patients.
authors: Digestive and Liver Disease Unit, S. Andrea Hospital, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy.
authors: Matteo
authors: M
authors: Piciucchi
authors: Stefano
authors: S
authors: Crippa
authors: Marco
authors: M
authors: Del Chiaro
authors: Roberto
authors: R
authors: Valente
authors: Raffaele
authors: R
authors: Pezzilli
authors: Massimo
authors: M
authors: Falconi
authors: Gianfranco
authors: G
authors: Delle Fave
authors: Gabriele
authors: G
authors: Capurso
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000401:mortality* / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000628:therapy; D002291:Carcinoma, Papillary / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies