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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

Radiologic findings of multifocal intraductal papillary mucinous neoplasms. (A and B) MRI and CT scan revealed pancreas swelling with peri-pancreatic infiltration, implying acute pancreatitis. There were variable sized multiple cystic lesions communicated with the main pancreatic duct in the entire pancreas, suggesting multiple BD-IPMNs. Main pancreatic duct size was measured at 3 mm. (C and D) Multifocal BD-IPMNs in the pancreas with maximal diameter measured at 3.5 cm in the uncinate process without evidence of dilatation of main pancreatic duct or mural nodules.
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Figure 2: Radiologic findings of multifocal intraductal papillary mucinous neoplasms. (A and B) MRI and CT scan revealed pancreas swelling with peri-pancreatic infiltration, implying acute pancreatitis. There were variable sized multiple cystic lesions communicated with the main pancreatic duct in the entire pancreas, suggesting multiple BD-IPMNs. Main pancreatic duct size was measured at 3 mm. (C and D) Multifocal BD-IPMNs in the pancreas with maximal diameter measured at 3.5 cm in the uncinate process without evidence of dilatation of main pancreatic duct or mural nodules.

Mentions: We defined multifocal BD-IPMNs as two or more cystic lesions in any part of the pancreas that had communication with the main pancreatic duct. Multifocal BD-IPMN was diagnosed using computed tomography (CT) scan or magnetic resonance cholangiopancratography (MRCP) (Fig. 2). MRCP was performed on a 1.5 Tesla MR scanner (Magnetom Avanto, Siemens Medical Solutions) with intravenous injection of Gd-BOPTA (gadobenate dimeglumine, Multihance®). Of the 22 patients, 20 were evaluated by both CT and MRCP. Malignancy of BD-IPMNs was suspected when the followings were observed in preoperative imaging studies: diffused main pancreatic duct dilatation over 10 mm, tumor size over 3 cm, enhanced mural nodules, and lymphadenopathy. Pancreatic resection was performed for all suspicious malignant lesions, whereas benign-looking BD-IPMNs were left intact within the remnant pancreas.


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)

Radiologic findings of multifocal intraductal papillary mucinous neoplasms. (A and B) MRI and CT scan revealed pancreas swelling with peri-pancreatic infiltration, implying acute pancreatitis. There were variable sized multiple cystic lesions communicated with the main pancreatic duct in the entire pancreas, suggesting multiple BD-IPMNs. Main pancreatic duct size was measured at 3 mm. (C and D) Multifocal BD-IPMNs in the pancreas with maximal diameter measured at 3.5 cm in the uncinate process without evidence of dilatation of main pancreatic duct or mural nodules.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Radiologic findings of multifocal intraductal papillary mucinous neoplasms. (A and B) MRI and CT scan revealed pancreas swelling with peri-pancreatic infiltration, implying acute pancreatitis. There were variable sized multiple cystic lesions communicated with the main pancreatic duct in the entire pancreas, suggesting multiple BD-IPMNs. Main pancreatic duct size was measured at 3 mm. (C and D) Multifocal BD-IPMNs in the pancreas with maximal diameter measured at 3.5 cm in the uncinate process without evidence of dilatation of main pancreatic duct or mural nodules.
Mentions: We defined multifocal BD-IPMNs as two or more cystic lesions in any part of the pancreas that had communication with the main pancreatic duct. Multifocal BD-IPMN was diagnosed using computed tomography (CT) scan or magnetic resonance cholangiopancratography (MRCP) (Fig. 2). MRCP was performed on a 1.5 Tesla MR scanner (Magnetom Avanto, Siemens Medical Solutions) with intravenous injection of Gd-BOPTA (gadobenate dimeglumine, Multihance®). Of the 22 patients, 20 were evaluated by both CT and MRCP. Malignancy of BD-IPMNs was suspected when the followings were observed in preoperative imaging studies: diffused main pancreatic duct dilatation over 10 mm, tumor size over 3 cm, enhanced mural nodules, and lymphadenopathy. Pancreatic resection was performed for all suspicious malignant lesions, whereas benign-looking BD-IPMNs were left intact within the remnant pancreas.

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