Clinical fate of branch duct and mixed forms of intraductal papillary mucinous neoplasia of the pancreas
Article first published online: 19 MAY 2009
© 2009 The Authors. Journal compilation © 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 24, Issue 7, pages 1211–1217, July 2009
How to Cite
Bournet, B., Kirzin, S., Carrère, N., Portier, G., Otal, P., Selves, J., Musso, C., Suc, B., Moreau, J., Fourtanier, G., Pradère, B., Lazorthes, F., Escourrou, J. and Buscail, L. (2009), Clinical fate of branch duct and mixed forms of intraductal papillary mucinous neoplasia of the pancreas. Journal of Gastroenterology and Hepatology, 24: 1211–1217. doi: 10.1111/j.1440-1746.2009.05826.x
- Issue published online: 29 JUL 2009
- Article first published online: 19 MAY 2009
- Accepted for publication 9 January 2009.
- intraductal papillary mucinous neoplasia of the pancreas;
- natural history;
- pancreatic cancer;
- pancreatic surgery
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.