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Keywords:

  • ERCP;
  • IPMN;
  • malignancy;
  • pancreas

Abstract

Background and Aim

The evidence for main pancreatic duct intraductal papillary mucinous neoplasms (MPD-IPMN) malignancy is based predominantly on investigation of resected cases, and the natural history is still unclear. The aim of the present study is to investigate the natural history of MPD-IPMN and examine potential predictors of disease progression in MPD-IPMN patients who conformed to “high-risk stigmata” criteria.

Methods

This study included consecutive 20 follow-up patients and 19 surgical patients with “high-risk stigmata” MPD-IPMN, in whom the diameter of the MPD was > 10 mm, branch duct was < 5 mm, and who underwent clinical follow up for ≥ 2 years.

Results

Among surgical patients, mural nodules and MPD diameter of invasive patients were significantly different compared with non-invasive patients. On the other hand, among follow-up patients, univariate analysis revealed the following potential predictors for disease progression: diameter of MPD ≥ 15 mm (hazard ratio [HR], 20.9; 95% confidence interval [CI], 2.59–173.4; P < 0.01); and diffuse lesions of MPD-IPMN (HR, 4.46; 95% CI, 1.10–18.0; P = 0.04). On the other hand, multivariate analysis identified only diameter of MPD ≥ 15 mm (HR, 19.2; 95%CI, 1.87–198.5; P = 0.01) as a potential predictor of disease progression.

Conclusion

If MPD-IPMN patients have other severe complications or reasons for not undergoing surgical treatment, MPD diameter < 15 mm, negative cytology, and no mural nodules, conservative clinical follow up for several years may be an option.