Branch duct intraductal papillary mucinous neoplasm of the pancreas: single-center experience with 324 patients who underwent surgical resection.
10.14701/kjhbps.2015.19.3.113
- Author:
Young Il KIM
1
;
Sang Hyun SHIN
;
Ki Byung SONG
;
Dae Wook HWANG
;
Jae Hoon LEE
;
Kwang Min PARK
;
Young Joo LEE
;
Song Cheol KIM
Author Information
1. Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. drksc@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Intraductal papillary mucinous neoplasm;
Branch duct;
Pancreas;
Malignancy
- MeSH:
Bilirubin;
Diagnosis;
Humans;
Male;
Mucins*;
Multivariate Analysis;
Pancreas*;
Pancreatic Ducts;
Recurrence;
Survival Rate
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2015;19(3):113-120
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUNDS/AIMS: International treatment guidelines for branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas have been proposed, for features associated with malignancy and invasiveness. We investigated the clinicopathological characteristics that are predictive of malignancy or invasiveness and disease recurrence. METHODS: A review of 324 patients with resected and pathologically confirmed BD-IPMN, between March 1997 and December 2013, was conducted. RESULTS: There were 144 (44.4%) low grade dysplasia (LGD), 138 (42.6%) intermediate grade dysplasia (IMGD), 17 (5.3%) high grade dysplasia (HGD), and 25 (7.7%) invasive carcinoma (invIPMC) cases. The 5-year survival rates were 98.1% for LGD, 95.3% for IMGD, 100% for HGD, and 71.8% for invIPMC. Through a univariate analysis, the male sex was associated with malignancy, and CA19-9 was related to both malignant and invasive IPMN. The high risk or worrisome features of the international guidelines were associated with both malignant and invasive IPMN: the total bilirubin of the head/uncinate lesion, tumor size, mural nodule, and the size of the main pancreatic duct (MPD). Through a multivariate analysis, the male sex, elevated CA19-9, mural nodule, and dilated MPD diameter were independently correlated with the malignant IPMN. The elevated CA19-9 and dilated MPD diameter were also correlated with invasive carcinoma. The patient age and the initial pathological diagnosis were strongly associated with disease recurrence following surgical resection. CONCLUSIONS: The high risk or worrisome features in the current treatment guidelines for BD-IPMN are confined to the morphological characteristics of the disease. Patient factors and biological features should also be considered in order to develop optimal therapeutic or surveillance strategies.
