Pancreatic main-duct involvement in branch-duct IPMNs: an underestimated risk
OBJECTIVES: This study aimed to analyze a large single-center population of resected intraductal papillary mucinous neoplasms (IPMN) of the pancreas with respect to risk factors of malignant transformation. - BACKGROUND: There is international consensus that main-duct (MD) as well as mixed-type IPMN...
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| Hauptverfasser: | , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
2014
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| In: |
Annals of surgery
Year: 2014, Jahrgang: 260, Heft: 5, Pages: 848-856 |
| ISSN: | 1528-1140 |
| DOI: | 10.1097/SLA.0000000000000980 |
| Online-Zugang: | Verlag, lizenzpflichtig, Volltext: https://doi.org/10.1097/SLA.0000000000000980
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| Verfasserangaben: | Stefan Fritz, Miriam Klauss, Frank Bergmann, Oliver Strobel, Lutz Schneider, Jens Werner, Thilo Hackert, and Markus W. Büchler |
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| 245 | 1 | 0 | |a Pancreatic main-duct involvement in branch-duct IPMNs |b an underestimated risk |c Stefan Fritz, Miriam Klauss, Frank Bergmann, Oliver Strobel, Lutz Schneider, Jens Werner, Thilo Hackert, and Markus W. Büchler |
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| 520 | |a OBJECTIVES: This study aimed to analyze a large single-center population of resected intraductal papillary mucinous neoplasms (IPMN) of the pancreas with respect to risk factors of malignant transformation. - BACKGROUND: There is international consensus that main-duct (MD) as well as mixed-type IPMNs should be treated surgically due to a high risk of malignancy. In contrast, there is an ongoing controversy about surgery of branch-duct type IPMN (BD-IPMN). - METHODS: All consecutive patients who underwent surgery for IPMN between January 2004 and December 2012 were included. Clinical characteristics and preoperative imaging were correlated with histopathological features. - RESULTS: A total of 512 patients underwent pancreatic surgery and had a histological proof of IPMN. According to preoperative imaging, 74 patients had MD-IPMN (14%), 205 mixed-type (40%), and 233 suspected BD-IPMN (46%). On histopathology, 162 of 512 patients revealed low-grade, 105 moderate, and 52 high-grade dysplasia. One hundred ninety-three IPMN patients (38%) suffered from invasive carcinoma. Among invasive IPMNs, the majority (58%) were mixed-type lesions according to preoperative imaging. Of 141 Sendai negative BD-IPMNs, a malignancy rate of 18% (high-grade dysplasia and invasive carcinoma) was found. Most interesting, 29% of suspected BD-IPMNs (67/233) revealed histological involvement of the main pancreatic duct not evident in preoperative imaging. - CONCLUSIONS: All subtypes of IPMNs display a relevant risk for malignant transformation. By abdominal imaging, many IPMNs are misclassified as BD-IPMNs but reveal mixed-type lesions in histopathology. Because currently available preoperative diagnostics are not sufficient to reliably diagnose BD-IPMNs, surgical resection for suspected small branch-duct IPMN should be considered in patients fit for surgery. | ||
| 650 | 4 | |a Adenocarcinoma, Mucinous | |
| 650 | 4 | |a Adult | |
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Aged, 80 and over | |
| 650 | 4 | |a Biomarkers | |
| 650 | 4 | |a Carcinoma, Pancreatic Ductal | |
| 650 | 4 | |a Carcinoma, Papillary | |
| 650 | 4 | |a Diagnostic Imaging | |
| 650 | 4 | |a Female | |
| 650 | 4 | |a Humans | |
| 650 | 4 | |a Male | |
| 650 | 4 | |a Middle Aged | |
| 650 | 4 | |a Neoplasm Grading | |
| 650 | 4 | |a Neoplasm Invasiveness | |
| 650 | 4 | |a Pancreatic Ducts | |
| 650 | 4 | |a Prospective Studies | |
| 650 | 4 | |a Risk Factors | |
| 650 | 4 | |a Treatment Outcome | |
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