Importance of main pancreatic duct dilatation in IPMN undergoing surveillance

Marchegiani, Giovanni; Andrianello, Stefano; Morbin, Giorgia; Secchettin, Erica; D’Onofrio, Mirko; Robertis, Riccardo De; Malleo, Giuseppe; Bassi, Claudio

doi:10.1002/bjs.10948

Cited by 35 publications

(25 citation statements)

References 31 publications

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“…Despite good values of sensitivity and negative predictive value, the Sendai criteria showed low specificity, increasing the risk of overtreatment. Sendai guidelines achieved the goal of avoiding fatal errors in the case of potentially malignant PCNs but also led to 75% of potentially unrequested resections (20, 24, 25).…”

Section: Guidelinesmentioning

confidence: 99%

Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

et al. 2020

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Background and Aims: Pancreatic cysts are increasingly diagnosed, mainly during abdominal imaging performed for other reasons. Between pancreatic cystic neoplasm, intraductal papillary mucinous neoplasms are the most common pre-malignant entities. Intraductal papillary mucinous neoplasms involving side branches overall harbor a low risk of malignancy, and in the recent past, a progressively more conservative approach has been consolidated. Purpose of this report is to summarize the evidence supporting the current practice for the management of branch duct intraductal papillary mucinous neoplasm and to offer a useful practical guide from first observation to post-operative follow-up. Materials and Methods: Review of the most important scientific literature on intraductal papillary mucinous neoplasms was made. In this review article, we also report the experience of a high volume center in managing Pancreatic cystic neoplasms. Results: The correct management during surveillance still is a matter of debate, since many guidelines have been published suggesting different clinical approaches. Recently, follow-up discontinuation has also been proposed in selected cases. Conclusion: Despite significant improvements made by the increase of evidence, selecting surgical candidates because of an increased risk of malignant progression remains an unsolved issue and a hot topic for pancreatologists.

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Section: Guidelinesmentioning

confidence: 99%

Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

et al. 2020

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“…Main pancreatic duct dilatation could represent an indirect sign of the presence of neoplastic papillae growing into the duct, too. [20] Although, there have been recent studies on the significance of duct abnormalities in the mass detection, we could not identify any studies aimed at investigating the association of duct dilatation and operability in the current literature based on our research. [19] The present study investigated the association of pancreatic duct diameter and duct/parenchymal thickness ratio with resectability in the adenocarcinomas in the head of the pancreas and the potential to use these parameters in predicting operability or inoperability.…”

Section: Discussionmentioning

confidence: 87%

Pankreas Adenokarsinomlarında Operabilitenin Belirlenmesinde Pankreatik Kanal Çapının Güvenilirliği

Batur

Durmaz

2020

Journal of Contemporary Medicine

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Pankreas adenokarsinomlarının operabilitesini öngörmede pankreas kanalının çapını değerlendirmek. Gereç ve Yöntem: Histopatolojik olarak kanıtlanmış pankreas baş adenokarsinomu olan ve tanıdan önce nonspesifik semptomları nedeniyle multidetektör bilgisayarlı tomografi uygulanan 30 hastanın (21 erkek, 9 kadın; ort. yaş, 64.2 yıl; yaş aralığı 41-93 yıl) klinik ve görüntüleme bulgularını inceledik. Eşlik eden sekonder bulgular da analiz edildi. Bulgular: Pankreas başı adenokarsinomu olan 30 hasta değerlendirildi. Bunlardan 13'ünün (% 43,3) operabl olduğu (A Grubu) ve 17'sinin (% 56,7) radyolojik ve cerrahi olarak inoperabl olduğu (B Grubu) bulundu. Grup A hastalarında dilate pankreas kanalının ortalama çapı 5.80 mm ve Grup B hastalarında 9.15 mm ölçüldü (p = 0.001). Pankreas kanalı çapının bez genişliğine oranı Grup A'da 0.46 ve Grup B'de 0.62 bulundu (p = 0.001). Koledok dilatasyonu, tümör büyüklüğü ve ilk başvuru şikayetleri gibi eşlik eden sekonder belirtiler iki grup arasında anlamlı bir farklılık göstermedi. Sonuç: Ana pankreas kanalı çapı ve/veya kanal çapının bez genişliğine oranı, pankreas adenokarsinomlarının operabilitesini öngörmede faydalı olabilir.

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“…Dilatation of the main duct is considered to be a strong risk feature for malignancy, yet controversy persists regarding optimal duct diameter cut-off for resection and the need for either observation or resection in main duct IPMNs[23,24]. The European guidelines recommend resection in all fit individuals, the IAP guidelines require the presence of any high-risk stigmata, the ACG recommends referral to a multidisciplinary team discussion whereas the AGA guidelines do not mention this group with main duct dilatation specifically.…”

Section: Ipmns Of Main Duct Branch Duct and Mixed Typementioning

confidence: 99%

Observation or resection of pancreatic intraductal papillary mucinous neoplasm: An ongoing tug of war

Aunan¹,

Jamieson²,

Søreide³

2019

WJGO

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An increasing number of patients are being referred to pancreatic centres around the world due to often incidentally discovered cystic neoplasms of the pancreas. The evaluation and management of pancreatic cystic neoplasms is a controversial topic and with existing guidelines based on a lack of strong evidence there is discordance between centres and guidelines with regard to when to offer surgery and when to favour surveillance. The frequency, duration and modality of surveillance is also controversial as this is resource-consuming and must be balanced against the perceived benefits and risks involved. While there is consensus that the risk of malignancy should be balanced against the life-expectancy and comorbidities, the indications for surgery and surveillance strategies vary among the guidelines. Thus, the tug of war between surveillance or resection continues. Here we discuss the recommendations from guidelines with further accumulating data and emerging reports on intraductal papillary mucinous neoplasm in the literature.

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Importance of main pancreatic duct dilatation in IPMN undergoing surveillance

Abstract: In patients under surveillance, a dilated MPD alone was not associated with an increased incidence of malignancy in IPMN.

Cited by 35 publications

References 31 publications

Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

Branch Duct Intraductal Papillary Mucinous Neoplasms: Recommendations for Follow-Up and Surgery

Pankreas Adenokarsinomlarında Operabilitenin Belirlenmesinde Pankreatik Kanal Çapının Güvenilirliği

Observation or resection of pancreatic intraductal papillary mucinous neoplasm: An ongoing tug of war

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