Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Journal of Hepato-Biliary-Pancreatic Sciences
Published in: Journal of Hepato-Biliary-Pancreatic Sciences 4/2010

01-07-2010 | Original article

The distance of tumor spread in the main pancreatic duct of an intraductal papillary-mucinous neoplasm: where to resect and how to predict it

Authors: Ken-ichi Okada, Toshihide Imaizumi, Kenichi Hirabayashi, Masahiro Matsuyama, Naoki Yazawa, Shoichi Dowaki, Kosuke Tobita, Yasuo Ohtani, Yoshiaki Kawaguchi, Makiko Tanaka, Sadaki Inokuchi, Hiroyasu Makuuchi

Published in: Journal of Hepato-Biliary-Pancreatic Sciences | Issue 4/2010

Login to get access

Abstract

Background

The surgical decision regarding where to resect the pancreas is an important judgement that is directly linked to the surgical procedure. An appropriate surgical margin to resect intraductal papillary-mucinous neoplasm (IPMN) of the pancreas based on the distance of tumor spread (DTS) in the main pancreatic duct has not been adequately documented. We analyzed the appropriate surgical margin based on the DTS in the main pancreatic duct of IPMN and the positive rate at the pancreatic cut end margin.

Methods

Forty patients with main duct- or mixed-type IPMN diagnosed histopathologically who underwent surgery at Tokai University Hospital between 1991 and 2008 were retrospectively analyzed. The resection line was determined to achieve a 2-cm surgical margin in patients with main duct- or mixed-type IPMN and as limited a resection as possible to remove the dilated branch duct in patients with branch duct-type IPMN according to macroscopic type. The dysplastic state of the epithelium was judged as positive for carcinoma in situ (high-grade dysplasia) or adenoma (very low to moderate dysplasia) and judged as negative for hyperplasia or normal.

Results

The mean DTS in the main pancreatic duct was 41.6 ± 30.0 mm, and that of the distance of tumor absence was 13.6 ± 12.4 mm. The positive rate at the pancreatic cut end margin in frozen sections was 29.7%. The final positive rate at the pancreatic cut end margin was 26.2%. There has been no evidence of local recurrence in the remnant pancreas. DTS in the main pancreatic duct of IPMN was correlated with the maximum diameter of the duct (R = 0.678).

Conclusion

Distance of tumor spread offered important insights about the appropriate site to resect the pancreas and the positive rate at the cut end margin in IPMN.
Literature
1.
Paye F, Sauvanet A, Terris B, Ponsot P, Vilgrain V, Hammel P, et al. Intraductal papillary mucinous tumors of the pancreas: pancreatic resections guided by preoperative morphological assessment and intraoperative frozen section examination. Surgery. 2000;127:536–44.CrossRefPubMed
2.
Gigot JF, Deprez P, Sempoux C, Descamps C, Metairie S, Glineur D, et al. Surgical management of intraductal papillary mucinous tumors of the pancreas: the role of routine frozen section of the surgical margin, intraoperative endoscopic staged biopsies of the Wirsung duct, and pancreaticogastric anastomosis. Arch Surg. 2001;136:1256–62.CrossRefPubMed
3.
Couvelard A, Sauvanet A, Kianmanesh R, Hammel P, Colnot N, Lévy P, et al. Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable: a prospective evaluation. Ann Surg. 2005;242:774–8.CrossRefPubMed
4.
Sauvanet A, Partensky C, Sastre B, Gigot JF, Fagniez PL, Tuech JJ, et al. Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery. 2002;132:836–43.CrossRefPubMed
5.
Schnelldorfer T, Sarr MG, Nagorney DM, Zhang L, Smyrk TC, Qin R, et al. Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Arch Surg. 2008;143:639–46.CrossRefPubMed
6.
King J, Kazanjian K, Matsumoto J, Reber HA, Yeh MW, Hines OJ, et al. Distal pancreatectomy: incidence of postoperative diabetes. J Gastrointest Surg. 2008;12:1548–53.CrossRefPubMed
7.
Nagai K, Doi R, Kida A, Kami K, Kawaguchi Y, Ito T, et al. Intraductal papillary mucinous neoplasms of the pancreas: clinicopathologic characteristics and long-term follow-up after resection. World J Surg. 2008;32:271–8.CrossRefPubMed
8.
Tanaka M. Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and treatment. Pancreas. 2004;28:282–8.CrossRefPubMed
9.
Terris B, Ponsot P, Paye F, Hammel P, Sauvanet A, Molas G, et al. Intraductal papillary mucinous tumors of the pancreas confined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol. 2000;24:1372–7.CrossRefPubMed
10.
Salvia R, Fernández-del Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678–85.CrossRefPubMed
11.
Sugiyama M, Atomi Y. Intraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg. 1998;228:685–91.CrossRefPubMed
12.
Hruban RH, Takaori K, Klimstra DS, Adsay NV, Albores-Saavedra J, Biankin AV, et al. An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms. Am J Surg Pathol. 2004;28:977–87.CrossRefPubMed
13.
Adsay NV, Merati K, Basturk O, Iacobuzio-Donahue C, Levi E, Cheng JD, et al. Pathologically and biologically distinct types of epithelium in intraductal papillary mucinous neoplasms: delineation of an “intestinal” pathway of carcinogenesis in the pancreas. Am J Surg Pathol. 2004;28:839–48.CrossRefPubMed
14.
Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, et al. International Association of Pancreatology: international consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.CrossRefPubMed
15.
Waters JA, Schmidt CM. Intraductal papillary mucinous neoplasm—when to resect? Adv Surg. 2008;42:87–108.CrossRefPubMed
16.
Farnell MB. Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. J Gastrointest Surg. 2008;12:414–6.CrossRefPubMed
17.
Sugiyama M, Suzuki Y, Abe N, Mori T, Atomi Y. Management of intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol. 2008;43:181–5.CrossRefPubMed
18.
Schmidt CM, White PB, Waters JA, Yiannoutsos CT, Cummings OW, Baker M, et al. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg. 2007;246:644–51.CrossRefPubMed
19.
Yang AD, Melstrom LG, Bentrem DJ, Ujiki MB, Wayne JD, Strouch M, et al. Outcomes after pancreatectomy for intraductal papillary mucinous neoplasms of the pancreas: an institutional experience. Surgery. 2007;142:529–34.CrossRefPubMed
20.
Ishida M, Egawa S, Aoki T, Sakata N, Mikami Y, Motoi F, et al. Characteristic clinicopathological features of the types of intraductal papillary-mucinous neoplasms of the pancreas. Pancreas. 2007;35:348–52.CrossRefPubMed
21.
Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239:788–97.CrossRefPubMed
22.
Kim SC, Park KT, Lee YJ, Lee SS, Seo DW, Lee SK, et al. Intraductal papillary mucinous neoplasm of the pancreas: clinical characteristics and treatment outcomes of 118 consecutive patients from a single center. J Hepatobiliary Pancreat Surg. 2008;15:183–8.CrossRefPubMed
23.
Waters JA, Schmidt CM, Pinchot JW, White PB, Cummings OW, Pitt HA, et al. CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg. 2008;12:101–9.CrossRefPubMed
Metadata
Title
The distance of tumor spread in the main pancreatic duct of an intraductal papillary-mucinous neoplasm: where to resect and how to predict it
Authors
Ken-ichi Okada
Toshihide Imaizumi
Kenichi Hirabayashi
Masahiro Matsuyama
Naoki Yazawa
Shoichi Dowaki
Kosuke Tobita
Yasuo Ohtani
Yoshiaki Kawaguchi
Makiko Tanaka
Sadaki Inokuchi
Hiroyasu Makuuchi
Publication date
01-07-2010
Publisher
Springer Japan
Published in
Journal of Hepato-Biliary-Pancreatic Sciences / Issue 4/2010
Print ISSN: 1868-6974
Electronic ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0257-5

Other articles of this Issue 4/2010

Journal of Hepato-Biliary-Pancreatic Sciences 4/2010 Go to the issue

Topics

Surgical technique: new advancements for expanding indications and safety

Topics

Single HCC smaller than 2 cm: surgery or ablation

Original article

Recurrent intrahepatic cholangiocarcinoma: single-center experience using repeated hepatectomy and radiofrequency ablation

Topics

Surgical treatment of hilar cholangiocarcinoma in a new era: comparison among leading Eastern and Western centers, Leeds

Topics

Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience

Topics

Single HCC between 2 and 5 cm: the grey zone