Korean J Hepatobiliary Pancreat Surg.  2014 Nov;18(4):152-158. 10.14701/kjhbps.2014.18.4.152.

Surgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms of pancreas

• Kwon JH
• Kim SC
• Song KB
• Lee JH
• Hwang DW
• Park KM
• Lee YJ

• KMID: 1802231
• DOI: http://doi.org/10.14701/kjhbps.2014.18.4.152

Abstract

BACKGROUNDS/AIMS
Appropriate management for multifocal branch duct type intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas is still controversial. This study was intended to reveal surgical outcomes of surgical resection for multifocal BD-IPMNs, with BD-IPMNs in the remnant pancreas.
METHODS
Between January 1995 and December 2013, 699 patients underwent the pancreatic resection due to IPMN of pancreas in our institution. Among them, 37 patients showed multifocal BD-IPMNs. After excluding patients who had BD-IPMNs completely resected, medical records of 22 patients with remained BD-IPMNs in the remnant pancreas were retrospectively reviewed.
RESULTS
Mean patient age was 65+/-6.4 years. Types of surgery included central pancreatectomy (n=1), distal pancreatectomy (n=14), and standard pylorus-preserving pancreaticoduodenectomy (n=7). Specimen pathology showed that IPMN was either at low/intermediate-grade dysplasia (n=17) or at high-grade dysplasia (n=2). Three patients had IPMN associated with invasive carcinoma. Their mean follow-up period was 40.4 months. During follow-up, one mortality occurred 35.2 months after the operation which was not associated with IPMN. There was no clinically significant disease progression or recurrence of IPMN in the remnant pancreas during the follow-up period.
CONCLUSIONS
Our results support that we can safely preserve the pancreas parenchyma with multifocal BD-IPMNs. Benign-looking multifocal BD-IPMNs in the remnant pancreas do not affect the survival of patients.

Keyword

Pancreatectomy; Intraductal papillary mucinous neoplasms; Branch duct; Multifocal; Follow-up

MeSH Terms

Disease Progression
Follow-Up Studies
Humans
Medical Records
Mortality
Mucins*
Pancreas*
Pancreatectomy
Pancreaticoduodenectomy
Pathology
Recurrence
Retrospective Studies
Mucins

Figure

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  Fig. 1 Flow diagram of 699 patients who received pancreatic resection for IPMNs. DP: distal pancreatectomy; PD: pancreaticoduodenectomy; PPPD: pyloruspreserving. pancreaticoduodenectomy; TP: total pancreatectomy; CP: central pancreatectomy. *Eight patients: unknown ductal type. **PPPD was combined with pancreas tail resection.

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  Fig. 2 Radiologic findings of multifocal intraductal papillary mucinous neoplasms. (A and B) MRI and CT scan revealed pancreas swelling with peri-pancreatic infiltration, implying acute pancreatitis. There were variable sized multiple cystic lesions communicated with the main pancreatic duct in the entire pancreas, suggesting multiple BD-IPMNs. Main pancreatic duct size was measured at 3 mm. (C and D) Multifocal BD-IPMNs in the pancreas with maximal diameter measured at 3.5 cm in the uncinate process without evidence of dilatation of main pancreatic duct or mural nodules.

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  Fig. 3 Patient showing progressive dilatation of BD-IPMN. A 68 years-old male patient underwent pylorus-preserving pancreaticoduodenctomy due to increase in size of multifocal BD-IPMNs with mural nodules in the head. At 17 months after pancreatic resection, follow-up CT scan showed increase in diameter of two remnant BD-IPMNs in the pancreatic tail: (A) from 8.2 mm (B) to 11 mm, (C) from 10 mm (D) to 13.5 mm. Because both of them did not have any high-risk stigmata or worrisome features, we chose to cautiously observe these lesions.

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