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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

Patient showing progressive dilatation of BD-IPMN. A 68 years-old male patient underwent pylorus-preserving pancreaticoduodenctomy due to increase in size of multifocal BD-IPMNs with mural nodules in the head. At 17 months after pancreatic resection, follow-up CT scan showed increase in diameter of two remnant BD-IPMNs in the pancreatic tail: (A) from 8.2 mm (B) to 11 mm, (C) from 10 mm (D) to 13.5 mm. Because both of them did not have any high-risk stigmata or worrisome features, we chose to cautiously observe these lesions.
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Figure 3: Patient showing progressive dilatation of BD-IPMN. A 68 years-old male patient underwent pylorus-preserving pancreaticoduodenctomy due to increase in size of multifocal BD-IPMNs with mural nodules in the head. At 17 months after pancreatic resection, follow-up CT scan showed increase in diameter of two remnant BD-IPMNs in the pancreatic tail: (A) from 8.2 mm (B) to 11 mm, (C) from 10 mm (D) to 13.5 mm. Because both of them did not have any high-risk stigmata or worrisome features, we chose to cautiously observe these lesions.

Mentions: Pathologic results of resected pancreas are summarized in Table 2. A total of 17 patients showed low- or intermediate-grade dysplasia. Two patients were diagnosed as high-grade dysplasia. Three patients had IPMN with an associated invasive carcinoma. TNM stage of invasive IPMN carcinomas were IA in one patient and IB in two patients. None of them underwent postoperative adjuvant chemotherapy. Instead, they were observed regularly without evidence of recurrence during follow-up period. All pancreatic resection margins except three patients were negative for tumors. In these three patients, resection margins were IPMN with intermediate-grade dysplasia. Another three patients showed pancreatic intraepithelial lesions 1A (PanIN 1A) in resection margins. One patient had PanIN 1B in resection margin. No perioperative mortality occurred. The mean follow-up period was 40.4 months. During the follow-up, no disease-associated mortality occurred. One patient who had received renal transplantation six years before the pancreatic resection died 35.2 months after the operation. There was no disease progression (no increase in diameter) or recurrence of IPMN in the remnant pancreas during follow-up except in one patient who showed increase in diameters of two remnant BD-IPMNs (from 8.2 mm to 11 mm and from 10 mm to 13.5 mm) 17 months after the pancreatic resection (Fig. 3). Because there was no evidence of malignant features in the remnant lesions, this patient was observed regularly without any intervention. There was no perioperative morbidity. However, one patient showed recurrent pancreatitis after PPPD with pancreatic duct stone. The patient underwent re-operation for pancreaticojejunostomy (PJ) revision 40 months after the first surgery PPPD. After PJ revision, the patient has been doing well without any complication. The remaining twenty patients are now currently alive without any change in follow-up CT scans. No patient had tumor recurrence.


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)

Patient showing progressive dilatation of BD-IPMN. A 68 years-old male patient underwent pylorus-preserving pancreaticoduodenctomy due to increase in size of multifocal BD-IPMNs with mural nodules in the head. At 17 months after pancreatic resection, follow-up CT scan showed increase in diameter of two remnant BD-IPMNs in the pancreatic tail: (A) from 8.2 mm (B) to 11 mm, (C) from 10 mm (D) to 13.5 mm. Because both of them did not have any high-risk stigmata or worrisome features, we chose to cautiously observe these lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Patient showing progressive dilatation of BD-IPMN. A 68 years-old male patient underwent pylorus-preserving pancreaticoduodenctomy due to increase in size of multifocal BD-IPMNs with mural nodules in the head. At 17 months after pancreatic resection, follow-up CT scan showed increase in diameter of two remnant BD-IPMNs in the pancreatic tail: (A) from 8.2 mm (B) to 11 mm, (C) from 10 mm (D) to 13.5 mm. Because both of them did not have any high-risk stigmata or worrisome features, we chose to cautiously observe these lesions.
Mentions: Pathologic results of resected pancreas are summarized in Table 2. A total of 17 patients showed low- or intermediate-grade dysplasia. Two patients were diagnosed as high-grade dysplasia. Three patients had IPMN with an associated invasive carcinoma. TNM stage of invasive IPMN carcinomas were IA in one patient and IB in two patients. None of them underwent postoperative adjuvant chemotherapy. Instead, they were observed regularly without evidence of recurrence during follow-up period. All pancreatic resection margins except three patients were negative for tumors. In these three patients, resection margins were IPMN with intermediate-grade dysplasia. Another three patients showed pancreatic intraepithelial lesions 1A (PanIN 1A) in resection margins. One patient had PanIN 1B in resection margin. No perioperative mortality occurred. The mean follow-up period was 40.4 months. During the follow-up, no disease-associated mortality occurred. One patient who had received renal transplantation six years before the pancreatic resection died 35.2 months after the operation. There was no disease progression (no increase in diameter) or recurrence of IPMN in the remnant pancreas during follow-up except in one patient who showed increase in diameters of two remnant BD-IPMNs (from 8.2 mm to 11 mm and from 10 mm to 13.5 mm) 17 months after the pancreatic resection (Fig. 3). Because there was no evidence of malignant features in the remnant lesions, this patient was observed regularly without any intervention. There was no perioperative morbidity. However, one patient showed recurrent pancreatitis after PPPD with pancreatic duct stone. The patient underwent re-operation for pancreaticojejunostomy (PJ) revision 40 months after the first surgery PPPD. After PJ revision, the patient has been doing well without any complication. The remaining twenty patients are now currently alive without any change in follow-up CT scans. No patient had tumor recurrence.

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