Outcomes after pancreatectomy for intraductal papillary mucinous neoplasms of the pancreas: An institutional experience

Yang, A.D.; Melstrom, Laleh G.; Bentrem, David J.; Ujiki, Michael; Wayne, Jeffrey D.; Strouch, Matthew J.; Bell, Richard H.; Rao, Sam; Talamonti, Mark S.

doi:10.1016/j.surg.2007.07.007

Cited by 29 publications

(33 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some investigators have suggested age, tumor location, serum total bilirubin, and CEA level as predictive factors for malignant or invasive IPMN, but these factors were not significant predictors in our study [1,5,16,17]. Some investigators have used ultrasonography-guided or endoscopy-guided biopsies to diagnose IPMN, but diagnostic methods based on cytology are known to have relatively high false-negative rates and to carry the risk of peritoneal seeding [10,11,[18][19][20].…”

Section: Discussioncontrasting

confidence: 54%

Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Hwang

Jang

Lee

et al. 2010

Langenbecks Arch Surg

115

106

View full text Add to dashboard Cite

Purpose The clinical importance of intraductal papillary mucinous neoplasm of the pancreas (IPMN) has been increasing with a large number of newly diagnosed IPMN. This study was designed to explore the characteristics of resected IPMN and to determine the predictive factors for malignant and invasive IPMN. Methods Retrospective review of a prospectively collected database was performed on 187 consecutive patients following IPMN surgery between 1994 and 2008 at a tertiary institute. The main duct type IPMN was radiologically defined as main pancreatic duct dilation >5 mm rather than previously defined ≥10 mm. Results The morphologic types of IPMN included 28 main duct (IPMN-M, 15.0%), 118 branch duct (IPMN-Br, 63.1%), and 41 mixed (IPMN-Mixed, 21.9%) IPMNs. There were 23 patients with adenoma, 106 borderline atypia, 15 carcinoma in situ, and 43 invasive carcinoma. Sixty-nine extrapancreatic malignancies were diagnosed in 61 (32.6%) patients. Based on multivariate analysis, IPMN-M was statistically significant predictor of malignancy/ invasiveness (p=0.013/p=0.028). In patients with IPMNBr, the presence of mural nodule was a predictive factor for malignancy/invasiveness (p=0.005/p=0.002). In patients with IPMN-Mixed, mural nodule (p=0.038/p=0.047) and wall thickening (>2 mm, p=0.015/p=0.046) were risk factor for malignancy/invasiveness and elevated CA19-9 (p=0.046) for invasiveness. Conclusions The main pancreatic duct diameter (>5 mm) is a significant predictor for malignancy and invasiveness. Therefore, IPMN patients with main pancreatic duct dilatation (>5 mm) should be considered surgical resection. Mural nodule is the indicator of surgery in IPMN-Br and IPMN-Mixed. In case of IPMN-Mixed with wall thickening or elevated serum CA19-9, surgical resection is recommended.

show abstract

Section: Discussioncontrasting

confidence: 54%

Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Hwang

Jang

Lee

et al. 2010

Langenbecks Arch Surg

115

106

View full text Add to dashboard Cite

show abstract

“…(2) The main type and the malignant branch type intraductal papillary mucinous neoplasms represent a contraindication for a parenchyma-sparing pancreatic resection, because high recurrence rates were reported. (6,8,49,50) However, good oncological outcomes were reported in several studies, for the branch type intraductal papillary mucinous neoplasms with minimally-invasive or in situ adenocarcinoma, when a margins negative resection could be accomplished. (17,51,52) Uncommon indications for a CP are chronic pancreatitis (17,29) and pancreatic trauma.…”

Section: Indications and Contraindications For A Central Pancreatectomentioning

confidence: 99%

Central pancreatectomy revisited

Dumitraşcu¹,

Popescu²

2015

JTMR

View full text Add to dashboard Cite

Central pancreatectomy (CP) is a parenchyma-sparing alternative resection to distal pancreatectomy, for benign and low malignant potential tumors located on the pancreatic isthmus and/ or body. Pancreatic metastases of other neoplasia might also benefit after a CP, in selected patients. Dagradi and Serio described the modern technique of CP, while Iacono introduced it in current clinical practice. An open CP represents the standard, but there is an emerging role for the minimally-invasive approach, which might become a standard for CP in experienced centers, particularly for the robotic approach. The rationale of a CP was to preserve the postoperative pancreatic functions because it implies the loss of a minimal amount of normal pancreatic tissue. However, the real clinical benefit of a CP is still controversial. High overall morbidity and pancreatic fistula rates were reported after a CP. However, most of the complications after a CP have been conservatively managed, with almost zero mortality. A CP has a minimal impact on the postoperative pancreatic functions; the diabetes mellitus rate after a CP is significantly lower, compared with the distal pancreatectomies. A proper selection of candidates for a CP is recommended. Thus, tumors located on the pancreatic isthmus are more likely to benefit after a CP, because the alternative surgical technique in these patients is an extended left pancreatectomy, a procedure with increased risk of postoperative pancreatic insufficiencies. Individual patient-related factors should be taken into consideration in the selection of the patients. Thus, a CP should be used in young patients, non-obese and without diabetes mellitus, with a good biological status, which might be able to overcome the potential postoperative complications. A CP can be safely incorporated into an experienced pancreatic surgeon armamentarium, albeit it represents an uncommon pancreatic resection. Abbreviations: Central pancreatectomy (CP); Physiologic and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM).

show abstract

“…Daneben sind Segmentresekti- [36]. Erst wenn die Nachresektion erneut neoplastische Veränderungen am Resektionsrand ergibt und der verbleibende Rest für eine erneute Nachresektion zu klein ist, lässt sich eine totale Pankreatektomie nicht vermeiden [37].…”

Section: Operationsverfahren Und -Technikunclassified

Zystische Tumoren des Pankreas

Grützmann

Saeger

2010

Chirurg

View full text Add to dashboard Cite

Cysts of the pancreas most often develop after chronic or acute inflammation of the pancreas. Cystic neoplasia of the pancreas have been increasingly recognized in clinical practice and 90% are represented by four types: serous microcystic (SCN), mucinous cystic (MCN), intraductal papillary-mucinous (IPMN) and solid pseudopapillary (SPN) neoplasia. IPMN is the most common form nowadays and main duct and branch duct types can be differentiated by morphology. This classification is of prognostic and therapeutic relevance. While main duct IPMNs have a high risk of malignant progression and resection is therefore recommended, branch duct IPMNs have a much lower risk of harboring malignancy. Small branch duct IPMNs (<2 cm) without symptoms or mural nodules can be managed by periodic surveillance. Recently, it has become clear that IPMN constitutes a heterogeneous group with at least four subtypes. Their stratification reveals that the various subtypes of IPMN have different biological properties with different prognostic implications, but the subclassification is usually not known prior to surgery. Moreover, even differentiation between inflammatory and neoplastic cysts can be challenging. Clear indications for resection are local complications (jaundice or gastric outlet obstruction), large and increasing tumors, symptoms or secretion of mucinous fluid from the papilla of Vater.

show abstract

Outcomes after pancreatectomy for intraductal papillary mucinous neoplasms of the pancreas: An institutional experience

Cited by 29 publications

References 11 publications

Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Clinicopathologic analysis of surgically proven intraductal papillary mucinous neoplasms of the pancreas in SNUH: a 15-year experience at a single academic institution

Central pancreatectomy revisited

Zystische Tumoren des Pankreas

Contact Info

Product

Resources

About