Outcome of Invasive and Noninvasive Intraductal Papillary‐Mucinous Neoplasms of the Pancreas (IPMN): A 10‐year Experience

Abstract

Since the introduction of IPMN in 1996, even specialized centers have had to deal with a learning curve. By reevaluating all cystic or small solid tumors, centers can improve and their patients' treatment can be optimized. Because the preoperative diagnostic methods are not sensitive enough to differentiate between benign and malignant lesions, surgery is advocated for all main duct IPMN, because they have a high malignant potential. For branch duct IPMN, surgery is advocated if the lesion is symptomatic, >3 cm, or has enlarged nodules.

Adjuvant Radiotherapy in the Treatment of Invasive Intraductal Papillary Mucinous Neoplasm of the Pancreas: an Analysis of the Surveillance, Epidemiology, and End Results Registry

“…Lymph node involvement was highly predictive of worsened survival: the 5-year OS for lymph-node-positive invasive IPMN in the present study was 12% (published range: 0-45%) compared with 42% for patients with node-negative tumors (40-85%). [5][6][7][8][9]12,36 The difference in OS between patients with versus without lymph node involvement is consistent with previous reports.…”

“…[5][6][7][8][9][10][11] Unfortunately, approximately 25% of all resected IPMNs are invasive. 12 Malignant transformation of IPMN from adenomatous stage to noninvasive and subsequently invasive IPMN is similar to the development of pancreatic ductal adenocarcinoma from pancreatic intraepithelial neoplasia, though, unlike pancreatic adenocarcinoma, the natural history of invasive IPMN remains poorly defined.…”

Intraductal Papillary Mucinous Tumors of the Pancreas: Biology, Diagnosis, and Treatment

“…Only one large retrospective study with 136 resected IPMN samples from Johns Hopkins Hospital showed no prognostic relevance among different subtypes [20]. The strongest adverse predictor of survival in IPMN is the presence of invasive carcinoma [61][62][63][64][65].…”

“…A convincing statement for a follow-up program is confounded because most of the studies do not distinguish between MD-IPMN and BD-IPMN, or between invasive and noninvasive IPMN. There are some studies with an evidence level of 4 and a consensus article giving information regarding recurrence and follow-up [36,59,61,66,110,111]. A cooperative series from the Massachusetts General Hospital and the University of Verona showed a 100% disease-free survival rate for both noninvasive MD-IPMN and BD-IPMN.…”

Intraductal Papillary Mucinous Neoplasms of the Pancreas: Challenges and New Insights

“…So we have to perform the follow-up with MRCP by including a lengthening in • Invasive carcinoma: studies say that the risk of IPMN recurrence is 25-50% [62], and it recommendedsurveillanceevery6months [28]. If we diagnose patients, a recurrence of IPMNwillneedEUSforevaluation.…”