Clinical fate of branch duct and mixed forms of intraductal papillary mucinous neoplasia of the pancreas

• Published in: Journal of gastroenterology and hepatology Vol. 24; no. 7; pp. 1211 - 1217
• Main Authors: Bournet, Barbara, Kirzin, Sylvain, Carrère, Nicolas, Portier, Guillaume, Otal, Philippe, Selves, Janick, Musso, Carole, Suc, Bertrand, Moreau, Jacques, Fourtanier, Gilles, Pradère, Bernard, Lazorthes, Franck, Escourrou, Jean, Buscail, Louis
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.07.2009; Wiley-Blackwell; Wiley
• Subjects: Adenocarcinoma, Mucinous - mortality; Adenocarcinoma, Mucinous - pathology; Adenocarcinoma, Mucinous - surgery; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Pancreatic Ductal - mortality; Carcinoma, Pancreatic Ductal - pathology; Carcinoma, Pancreatic Ductal - surgery; Carcinoma, Papillary - mortality; Carcinoma, Papillary - pathology; Carcinoma, Papillary - surgery; Cystadenoma - mortality; Cystadenoma - pathology; Cystadenoma - surgery; Disease Progression; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; intraductal papillary mucinous neoplasia of the pancreas; Life Sciences; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; natural history; Neurons and Cognition; Pancreatectomy; pancreatic cancer; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; pancreatic surgery; Patient Selection; Risk Assessment; Time Factors; Treatment Outcome; Tumors; Malignant tumor; natural history; pancreatic cancer; Treatment; Surgery; Pancreas cancer; Gastroenterology; pancreatic surgery; Digestive diseases; intraductal papillary mucinous neoplasia of the pancreas; Pancreas; Cancer; Pancreatic disease; intraductal papillary mucinous neoplasia of the pancreas • natural history • pancreatic cancer • pancreatic surgery
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/j.1440-1746.2009.05826.x

Aims:  The aim of the present study was to assess the clinical fate of, and to gain new insights into, branch duct and mixed (predominantly main duct type) forms of intraductal papillary mucinous neoplasia of the pancreas (IPMN). Methods:  During a 17‐year period, 99 successive IPMN patients (52 men, 47 women; mean age, 64 years) were included and divided into two groups for further comparison: one group had branch duct IPMN, whereas the other had mixed IPMN. Results:  Patients from the mixed IPMN group (n = 52) displayed a greater rate of symptoms (83% vs 55%, P = 0.004), pancreatic resection (67% vs 38%, P = 0.007), malignancy (35% vs 13%, P = 0.017) and death (15% vs 4%, P = 0.09) than those from the branch duct IPMN group. A 38‐month follow up of non‐operated, symptom‐free patients confirmed that more than 85% of branch duct IPMN patients were asymptomatic without evidence of malignancy. Borderline lesions and carcinoma are found in up to 50% of symptomatic resected branch duct IPMN cases. Conclusion:  Patients with the mixed form of IPMN as well as with symptomatic branch duct IPMN should require pancreatic resection because of symptoms and the risk for malignancy. In silent branch duct IPMN without radiological signs of malignancy, a non‐operative watch‐and‐wait strategy can be discussed.