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 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 2/2011

01-02-2011 | Pancreatic Tumors

Invasive IPMN and MCN: Same Organ, Sifferent Outcomes?

Authors: Hamed Kargozaran, MD, Vu Vu, BS, Partha Ray, MD, Sanjay Bagaria, MD, Shawn Steen, MD, Xing Ye, MS, Singh Gagandeep, MD

Published in: Annals of Surgical Oncology | Issue 2/2011

Login to get access

Abstract

Background

The efficacy of surgery for invasive mucinous neoplasms is unclear. We examined the natural history of invasive mucinous cystic neoplasms (MCN) and invasive intraductal papillary mucinous neoplasms (IPMN) in patients who underwent pancreatic resection.

Methods

The Surveillance, Epidemiology, and End Results (SEER) database (1996–2006) was queried for cases of resected invasive MCN and IPMN. Demographics, tumor characteristics, and overall survival were examined using log-rank analysis and multivariate Cox regression model.

Results

Of 185 MCN cases and 641 IPMN cases, 73% and 48%, respectively, were women (P < 0.0001). Most (73%) IPMN were in the head of the pancreas; most (64%) MCN were in the tail/body (P < 0.0001). Lymph node metastasis was more common for IPMN than MCN (46% vs. 24%, P < 0.0001). Overall survival after resection was better for patients with stage I MCN vs. stage I IPMN (P = 0.0005), and it was better for patients with node-negative MCN vs. node-negative IPMN (P = 0.0061). There was no significant difference in survival of patients with stage IIA MCN vs. stage IIA IPMN (P = 0.5964), stage IIB MCN vs. stage IIB IPMN (P = 0.2262), or node-positive MCN vs. node-positive IPMN (P = 0.2263). Age older than 65 years (hazards ratio (HR) 1.71, P = 0.0046), high tumor grade (HR 2.68, P < 0.0001), higher T stage (HR 2.11, P < 0.0001), and IPMN histology (HR 1.90, P = 0.0040) predicted worse outcome in node-negative patients.

Conclusions

Our findings suggest that survival is better after resection of invasive MCN versus invasive IPMN when disease is localized within the pancreas, but this difference disappears in the presence of nodal metastasis or extrapancreatic extension.
Literature
1.
Compagno J, Oertel JE. Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol. 1978;69:573–80.PubMed
2.
Zamboni G, Scarpa A, Bogina G, et al. Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol. 1999;23:410–22.CrossRefPubMed
3.
Kloppel G SE, Longnecker DS, Capella C, Sobin LH. Histological typing of tumors of the exocrine pancreas. New York: Springer, 1996.
4.
Longnecker DAG, Hruban R, Intraductal papillary-mucinous neoplasms of the pancreas. Lyon: IARC, 2000.
5.
Fritz S, Warshaw AL, Thayer SP. Management of mucin-producing cystic neoplasms of the pancreas. Oncologist. 2009;14:125–36.CrossRefPubMed
6.
Sahani DV, Miller JC, del Castillo CF, et al. Cystic pancreatic lesions: classification and management. J Am Coll Radiol. 2009;6:376–80.CrossRefPubMed
7.
Hruban RH, Takaori K, Klimstra DS, 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
8.
Levy P, Jouannaud V, O’Toole D, et al. Natural history of intraductal papillary mucinous tumors of the pancreas: actuarial risk of malignancy. Clin Gastroenterol Hepatol. 2006;4:460–8.CrossRefPubMed
9.
Tanaka M, Kobayashi K, Mizumoto K, Yamaguchi K. Clinical aspects of intraductal papillary mucinous neoplasm of the pancreas. J Gastroenterol. 2005;40:669–75.CrossRefPubMed
10.
Wilentz RE, Albores-Saavedra J, Hruban RH. Mucinous cystic neoplasms of the pancreas. Semin Diagn Pathol. 2000;17:31–42.PubMed
11.
Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg. 2006;30:2236–45.CrossRefPubMed
12.
D’Angelica M, Brennan MF, Suriawinata AA, et al. Intraductal papillary mucinous neoplasms of the pancreas: an analysis of clinicopathologic features and outcome. Ann Surg. 2004;239:400–8.CrossRefPubMed
13.
Salvia R, Fernandez-del Castillo C, Bassi C, 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; discussion 685–7.CrossRefPubMed
14.
Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239:788–97; discussion 797–9.CrossRefPubMed
15.
Reddy RP, Smyrk TC, Zapiach M, et al. Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol. 2004;2:1026–31.CrossRefPubMed
16.
Crippa S, Salvia R, Warshaw AL, et al. Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg. 2008;247:571–9.CrossRefPubMed
17.
Riall TS, Stager VM, Nealon WH, et al. Incidence of additional primary cancers in patients with invasive intraductal papillary mucinous neoplasms and sporadic pancreatic adenocarcinomas. J Am Coll Surg. 2007;204:803–13; discussion 813–4.CrossRefPubMed
18.
Fernandez-del Castillo C, Targarona J, Thayer SP, et al. Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg. 2003;138:427–33; discussion 433–4.CrossRefPubMed
19.
Sarr MG, Murr M, Smyrk TC, et al. Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importance-current state-of-the-art and unanswered questions. J Gastrointest Surg. 2003;7:417-28.CrossRefPubMed
20.
Thompson LD, Becker RC, Przygodzki RM, et al. Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol. 1999;23:1-16.CrossRefPubMed
21.
Murakami Y, Uemura K, Sudo T, et al. Invasive intraductal papillary-mucinous neoplasm of the pancreas: comparison with pancreatic ductal adenocarcinoma. J Surg Oncol. 2009;100:13-8.CrossRefPubMed
22.
Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an increasingly recognized clinicopathologic entity. Ann Surg. 2001;234:313–21; discussion 321–2.CrossRefPubMed
23.
Maire F, Hammel P, Terris B, et al. Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut. 2002;51:717–22.CrossRefPubMed
24.
Shimada K, Sakamoto Y, Sano T, et al. Invasive carcinoma originating in an intraductal papillary mucinous neoplasm of the pancreas: a clinicopathologic comparison with a common type of invasive ductal carcinoma. Pancreas. 2006;32:281–7.CrossRefPubMed
25.
Woo SM, Ryu JK, Lee SH, et al. Survival and prognosis of invasive intraductal papillary mucinous neoplasms of the pancreas: comparison with pancreatic ductal adenocarcinoma. Pancreas. 2008;36:50–5.CrossRefPubMed
26.
Fasanella KE, McGrath K. Cystic lesions and intraductal neoplasms of the pancreas. Best Pract Res Clin Gastroenterol. 2009;23:35–48.CrossRefPubMed
27.
Devaney K, Goodman ZD, Ishak KG. Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol. 1994;18:1078–91.CrossRefPubMed
28.
Tenti P, Romagnoli S, Pellegata NS, et al. Primary retroperitoneal mucinous cystoadenocarcinomas: an immunohistochemical and molecular study. Virchows Arch. 1994;424:53–7.CrossRefPubMed
29.
Carpizo DR, Allen PJ, Brennan MF. Current management of cystic neoplasms of the pancreas. Surgeon. 2008;6:298–307.CrossRefPubMed
30.
31.
Tanaka M, Chari S, Adsay V, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.CrossRefPubMed
32.
Jang JY, Kim SW, Lee SE, et al. Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol. 2008;15:199–205.CrossRefPubMed
33.
Salvia R, Crippa S, Falconi M, et al. Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut. 2007;56:1086–90.CrossRefPubMed
34.
Allen PJ, D’Angelica M, Gonen M, et al. A selective approach to the resection of cystic lesions of the pancreas: results from 539 consecutive patients. Ann Surg. 2006;244:572–82.PubMed
35.
Sarr MG, Carpenter HA, Prabhakar LP, et al. Clinical and pathologic correlation of 84 mucinous cystic neoplasms of the pancreas: can one reliably differentiate benign from malignant (or premalignant) neoplasms? Ann Surg. 2000;231:205–12.CrossRefPubMed
36.
Chari ST, Yadav D, Smyrk TC, et al. Study of recurrence after surgical resection of intraductal papillary mucinous neoplasm of the pancreas. Gastroenterology. 2002;123:1500–7.CrossRefPubMed
37.
Bendix Holme J, Jacobsen N, Rokkjaer M, Kruse A. Total pancreatectomy in six patients with intraductal papillary mucinous tumour of the pancreas: the treatment of choice. HPB (Oxford). 2001;3:257–62.
38.
Bassi C, Sarr MG, Lillemoe KD, Reber HA. Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management. J Gastrointest Surg. 2008;12:645–50.CrossRefPubMed
39.
Artinyan A, Soriano PA, Prendergast C, et al. The anatomic location of pancreatic cancer is a prognostic factor for survival. HPB (Oxford). 2008;10:371–6.
40.
Schwarz RE, Smith DD: Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol. 2006;13:1189–200.CrossRefPubMed
Metadata
Title
Invasive IPMN and MCN: Same Organ, Sifferent Outcomes?
Authors
Hamed Kargozaran, MD
Vu Vu, BS
Partha Ray, MD
Sanjay Bagaria, MD
Shawn Steen, MD
Xing Ye, MS
Singh Gagandeep, MD
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 2/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1309-4

Other articles of this Issue 2/2011

Annals of Surgical Oncology 2/2011 Go to the issue

Hepatobiliary Tumors

Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis: A Prospective Comparative Study

Translational Research and Biomarkers

Serum Midkine Correlates with Tumor Progression and Imatinib Response in Gastrointestinal Stromal Tumors

Gynecologic Oncology

Pretherapeutic Extraperitoneal Laparoscopic Staging of Bulky or Locally Advanced Cervical Cancer

Head and Neck Oncology

Feasibility of Preservation of the Submandibular Gland During Neck Dissection in Patients With Early-Stage Oral Cancer

Thoracic Oncology

Improved Outcomes in the Management of Esophageal Cancer with the Addition of Surgical Resection to Chemoradiation Therapy

Endocrine Tumors

Incidental Thyroid Carcinoma by FDG-PET/CT: A Study of Clinicopathological Characteristics