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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2008

01-01-2008 | Gastrointestinal Oncology

Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?

Authors: Jin-Young Jang, MD, PhD, Sun-Whe Kim, MD, PhD, Seung Eun Lee, MD, Sung Hoon Yang, MD, Kuhn Uk Lee, MD, PhD, Young Joo Lee, MD, PhD, Song Chul Kim, MD, PhD, Duck Jong Han, MD, PhD, Dong Wook Choi, MD, PhD, Seong Ho Choi, MD, PhD, Jin Seok Heo, MD, PhD, Baik Hwan Cho, MD, PhD, Hee Chul Yu, MD, PhD, Dong Sup Yoon, MD, PhD, Woo Jung Lee, MD, PhD, Hee-Eun Lee, MD, Gyeong Hoon Kang, MD, PhD, Jeong Min Lee, MD, PhD

Published in: Annals of Surgical Oncology | Issue 1/2008

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Abstract

Background

The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to surgery or observation) has been issued on the management of branch duct type IPMN.

Methods

We retrospectively reviewed the clinicopathological data of 138 patients who underwent operations for IPMN between 1993 and 2006 at five institutes in Korea.

Results

Of 138 patients (mean age, 60.6 years; 87 men, 51 women), 76 underwent pancreatoduodenectomy, 39 distal pancreatectomy, 4 total pancreatectomy, and 20 limited pancreatic resection. There were 112 benign cases: 47 adenoma, 63 borderline cases, and 26 malignant cases, with 9 of these being noninvasive and 17 invasive. By univariate analysis, tumor size and the presence of a mural nodule were identified as meaningful predictors of malignancy. By receiver operating characteristic curve analysis, a tumor size of >2 cm was found to be the most valuable predictor of malignancy. When cases were classified according to tumor size and the presence of a mural nodule, the malignancy rate for a tumor ≤2 cm without a mural nodule was 9.2%, for a tumor of ≤2 cm plus a mural nodule was 25%, and for other conditions such as tumor >2 cm, >25%.

Conclusions

Many branch duct IPMNs are malignant. Surgical treatment is recommended, except in cases that are strongly suspected to be benign or cases that present a high operative risk. Observation is only recommended in patients with a tumor size of ≤2 cm without a mural nodule.
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Metadata
Title
Treatment Guidelines for Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: When Can We Operate or Observe?
Authors
Jin-Young Jang, MD, PhD
Sun-Whe Kim, MD, PhD
Seung Eun Lee, MD
Sung Hoon Yang, MD
Kuhn Uk Lee, MD, PhD
Young Joo Lee, MD, PhD
Song Chul Kim, MD, PhD
Duck Jong Han, MD, PhD
Dong Wook Choi, MD, PhD
Seong Ho Choi, MD, PhD
Jin Seok Heo, MD, PhD
Baik Hwan Cho, MD, PhD
Hee Chul Yu, MD, PhD
Dong Sup Yoon, MD, PhD
Woo Jung Lee, MD, PhD
Hee-Eun Lee, MD
Gyeong Hoon Kang, MD, PhD
Jeong Min Lee, MD, PhD
Publication date
01-01-2008
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 1/2008
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-007-9603-5

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