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Surgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms of pancreas.

Kwon JH, Kim SC, Song KB, Lee JH, Hwang DW, Park KM, Lee YJ - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: Their mean follow-up period was 40.4 months.Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs.Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Backgrounds/aims: Appropriate management for multifocal branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas is still controversial. This study was intended to reveal surgical outcomes of surgical resection for multifocal BD-IPMNs, with BD-IPMNs in the remnant pancreas.

Methods: Between January 1995 and December 2013, 699 patients underwent the pancreatic resection due to IPMN of pancreas in our institution. Among them, 37 patients showed multifocal BD-IPMNs. After excluding patients who had BD-IPMNs completely resected, medical records of 22 patients with remained BD-IPMNs in the remnant pancreas were retrospectively reviewed.

Results: Mean patient age was 65±6.4 years. Types of surgery included central pancreatectomy (n=1), distal pancreatectomy (n=14), and standard pylorus-preserving pancreaticoduodenectomy (n=7). Specimen pathology showed that IPMN was either at low/intermediate-grade dysplasia (n=17) or at high-grade dysplasia (n=2). Three patients had IPMN associated with invasive carcinoma. Their mean follow-up period was 40.4 months. During follow-up, one mortality occurred 35.2 months after the operation which was not associated with IPMN. There was no clinically significant disease progression or recurrence of IPMN in the remnant pancreas during the follow-up period.

Conclusions: Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs. Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of 699 patients who received pancreatic resection for IPMNs. DP: distal pancreatectomy; PD: pancreaticoduodenectomy; PPPD: pyloruspreserving. pancreaticoduodenectomy; TP: total pancreatectomy; CP: central pancreatectomy. *Eight patients: unknown ductal type. **PPPD was combined with pancreas tail resection.
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Figure 1: Flow diagram of 699 patients who received pancreatic resection for IPMNs. DP: distal pancreatectomy; PD: pancreaticoduodenectomy; PPPD: pyloruspreserving. pancreaticoduodenectomy; TP: total pancreatectomy; CP: central pancreatectomy. *Eight patients: unknown ductal type. **PPPD was combined with pancreas tail resection.

Mentions: Between January 1995 and December 2013, 699 patients underwent pancreatic resection for IPMN of the pancreas at the Department of Surgery in Asan Medical Center. The diagnosis of IPMN was confirmed by pathologic result for all cases. Among them, 337 patients had BD-IPMN. Of the 337 patients, 37 showed multifocality. Because the purpose of this study was to review the prognosis and fate of remaining pancreas with BD-IPMNs, we excluded 15 patients whose multifocal BD-IPMNs were completely removed through pancreatic resection (which means no residual BD-IPMNs in the remnant pancreas). Patient selection flow is illustrated at Fig. 1. Medical records of 22 patients who still had BD-IPMNs (with or without mixed type IPMNs) were retrospectively reviewed, including past medical histories, radiologic findings, laboratory data, and pathologic results.


Surgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms of pancreas.

Kwon JH, Kim SC, Song KB, Lee JH, Hwang DW, Park KM, Lee YJ - Korean J Hepatobiliary Pancreat Surg (2014)

Flow diagram of 699 patients who received pancreatic resection for IPMNs. DP: distal pancreatectomy; PD: pancreaticoduodenectomy; PPPD: pyloruspreserving. pancreaticoduodenectomy; TP: total pancreatectomy; CP: central pancreatectomy. *Eight patients: unknown ductal type. **PPPD was combined with pancreas tail resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4492346&req=5

Figure 1: Flow diagram of 699 patients who received pancreatic resection for IPMNs. DP: distal pancreatectomy; PD: pancreaticoduodenectomy; PPPD: pyloruspreserving. pancreaticoduodenectomy; TP: total pancreatectomy; CP: central pancreatectomy. *Eight patients: unknown ductal type. **PPPD was combined with pancreas tail resection.
Mentions: Between January 1995 and December 2013, 699 patients underwent pancreatic resection for IPMN of the pancreas at the Department of Surgery in Asan Medical Center. The diagnosis of IPMN was confirmed by pathologic result for all cases. Among them, 337 patients had BD-IPMN. Of the 337 patients, 37 showed multifocality. Because the purpose of this study was to review the prognosis and fate of remaining pancreas with BD-IPMNs, we excluded 15 patients whose multifocal BD-IPMNs were completely removed through pancreatic resection (which means no residual BD-IPMNs in the remnant pancreas). Patient selection flow is illustrated at Fig. 1. Medical records of 22 patients who still had BD-IPMNs (with or without mixed type IPMNs) were retrospectively reviewed, including past medical histories, radiologic findings, laboratory data, and pathologic results.

Bottom Line: Their mean follow-up period was 40.4 months.Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs.Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.

View Article: PubMed Central - PubMed

Affiliation: Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Backgrounds/aims: Appropriate management for multifocal branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas is still controversial. This study was intended to reveal surgical outcomes of surgical resection for multifocal BD-IPMNs, with BD-IPMNs in the remnant pancreas.

Methods: Between January 1995 and December 2013, 699 patients underwent the pancreatic resection due to IPMN of pancreas in our institution. Among them, 37 patients showed multifocal BD-IPMNs. After excluding patients who had BD-IPMNs completely resected, medical records of 22 patients with remained BD-IPMNs in the remnant pancreas were retrospectively reviewed.

Results: Mean patient age was 65±6.4 years. Types of surgery included central pancreatectomy (n=1), distal pancreatectomy (n=14), and standard pylorus-preserving pancreaticoduodenectomy (n=7). Specimen pathology showed that IPMN was either at low/intermediate-grade dysplasia (n=17) or at high-grade dysplasia (n=2). Three patients had IPMN associated with invasive carcinoma. Their mean follow-up period was 40.4 months. During follow-up, one mortality occurred 35.2 months after the operation which was not associated with IPMN. There was no clinically significant disease progression or recurrence of IPMN in the remnant pancreas during the follow-up period.

Conclusions: Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs. Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.

No MeSH data available.


Related in: MedlinePlus