Development of Pancreatic Cancer, Disease-specific Mortality, and All-Cause Mortality in Patients with Nonresected IPMNs: A Long-term Cohort Study

Nagata, Naoyoshi; Kawazoe, Akihito; Mishima, Saori; Wada, Tatsuya; Shimbo, Takuro; Sekine, Katsunori; Watanabe, Kazuhiro; Imbe, Koh; Kojima, Yasushi; Kumazawa, Keigo; Mihara, Fuminori; Tokuhara, Makoto; Edamoto, Yoshihiro; Igari, Toru; Yanase, Mikio; Mizokami, Masashi; Akiyama, Junichi; Uemura, Naomi

doi:10.1148/radiol.2015150131

Cited by 41 publications

(47 citation statements)

References 30 publications

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“…A recent study reported that an initial cyst size of 30 mm or above in BD‐IPMN was not associated with development of invasive IPMN or PDAC. In contrast, patients in the present study with primarily large cysts (at least 30 mm) who underwent initial surveillance had an increased risk (29 per cent) of malignant transformation during observation, compared with those with cysts smaller than 20 mm.…”

Section: Discussionmentioning

confidence: 97%

Management and outcomes of intraductal papillary mucinous neoplasms

et al. 2019

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Background This study evaluated the outcome and survival of patients with radiologically suspected intraductal papillary mucinous neoplasms (IPMNs). Methods IPMN management was reviewed according to Fukuoka risk factors and IPMN localization, differentiating main‐duct (MD), mixed‐type (MT) and branch‐duct (BD) IPMNs. Perioperative results were compared with those of patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) over the same interval (2010–2014). Overall (OS) and disease‐specific (DSS) survival rates were calculated and subgroups compared. Results Of 142 patients with IPMNs, 26 had MD‐IPMN, eight had MT‐IPMN and 108 had BD‐IPMN. Some 74 per cent of patients with MD‐ and MT‐IPMN were managed by primary resection, whereas this was used in only 27·8 per cent of those with BD‐IPMN. The risk of secondary resection and malignant transformation for BD‐IPMNs smaller than 20 mm was 8 and 2 per cent respectively during follow‐up. Pancreatic head resection of IPMNs was associated with an increased risk of postoperative pancreatic fistula grade B/C compared with resection of PDAC (12 of 33 (36 per cent) versus 41 of 221 (18·6 per cent) respectively; P = 0·010), and greater morbidity and mortality (Clavien–Dindo grade III: 15 of 33 (45 per cent) versus 56 of 221 (25·3 per cent) respectively; grade IV: 1 (3 per cent) versus 7 (3·2 per cent); grade V: 2 (6 per cent) versus 2 (0·9 per cent); P = 0·008). Five‐year OS and DSS rates in patients with MD‐IPMN were worse than those for MT‐ and BD‐IPMN (OS: 44, 86 and 97·4 per cent respectively, P < 0·001; DSS: 60, 100 and 98·6 per cent; P < 0·001). Patients with invasive IPMN had worse OS and DSS rates than those with non‐invasive dysplasia (OS: IPMN‐carcinoma (10 patients) 33 per cent, high‐grade dysplasia 100 per cent, intermediate‐grade dysplasia 63 per cent, low grade‐dysplasia 100 per cent, P < 0·001; DSS: IPMN‐carcinoma 43 per cent, all grades of dysplasia 100 per cent, P < 0·001). Patients with high‐risk stigmata had poorer survival than those without risk factors (OS: high‐risk stigmata (35 patients) 55 per cent, worrisome features (31) 95 per cent, no risk factors (76) 100 per cent, P < 0·001; DSS: 71, 100 and 100 per cent respectively, P < 0·001). Conclusion The risk of malignant transformation was very low for BD‐IPMNs, but the development of high‐risk stigmata was associated with disease‐specific mortality. Patients with IPMN had greater morbidity after resection than those having resection of PDAC.

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Section: Discussionmentioning

confidence: 97%

Management and outcomes of intraductal papillary mucinous neoplasms

et al. 2019

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“…Two recent cohorts of non‐operated patients with high‐risk IPMNs deserve discussion. In a study by Nagata and colleagues, among 285 patients initially kept under observation, 13 had main‐duct IPMNs and 41 had branch‐duct IPMNs with cysts of at least 30 mm. In branch‐duct IPMNs overall mortality was higher than disease‐specific mortality.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of mortality in patients with high-risk intraductal papillary mucinous neoplasms under observation

Vanella

Crippa

Archibugi

et al. 2018

British Journal of Surgery

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“…1). This distinction has clinical relevance because MD involvement has been identified as a predictor of malignant transformation (20)(21)(22)(23). A MD dilation over 9 mm is considered to be a "high-risk stigmata" whereas a dilation comprised between 5-9 mm is considered as a "worrisome feature" for malignancy (24).…”

Section: Introductionmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

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Development of Pancreatic Cancer, Disease-specific Mortality, and All-Cause Mortality in Patients with Nonresected IPMNs: A Long-term Cohort Study

Cited by 41 publications

References 30 publications

Management and outcomes of intraductal papillary mucinous neoplasms

Management and outcomes of intraductal papillary mucinous neoplasms

Meta-analysis of mortality in patients with high-risk intraductal papillary mucinous neoplasms under observation

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

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