Pancreatic main-duct involvement in branch-duct IPMNs

• Verfasst von: Fritz, Stefan [VerfasserIn]
• Verfasst von: Klauß, Miriam [VerfasserIn]
• Verfasst von: Bergmann, Frank [VerfasserIn]
• Verfasst von: Strobel, Oliver [VerfasserIn]
• Verfasst von: Schneider, Lutz [VerfasserIn]
• Verfasst von: Werner, Jens [VerfasserIn]
• Verfasst von: Hackert, Thilo [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Titel: Pancreatic main-duct involvement in branch-duct IPMNs
• Titelzusatz: an underestimated risk
• Verf.angabe: Stefan Fritz, Miriam Klauss, Frank Bergmann, Oliver Strobel, Lutz Schneider, Jens Werner, Thilo Hackert, and Markus W. Büchler
• Jahr: 2014
• Umfang: 9 S.
• Fussnoten: Gesehen am 13.01.2021
• Titel Quelle: Enthalten in: Annals of surgery
• Ort Quelle: [S.l.] : Lippincott Williams & Wilkins, 1885
• Jahr Quelle: 2014
• Band/Heft Quelle: 260(2014), 5, Seite 848-856
• ISSN Quelle: 1528-1140
• DOI: doi:10.1097/SLA.0000000000000980
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Adenocarcinoma, Mucinous
• Sach-SW: Adult
• Sach-SW: Aged
• Sach-SW: Aged, 80 and over
• Sach-SW: Biomarkers
• Sach-SW: Carcinoma, Pancreatic Ductal
• Sach-SW: Carcinoma, Papillary
• Sach-SW: Diagnostic Imaging
• Sach-SW: Female
• Sach-SW: Humans
• Sach-SW: Male
• Sach-SW: Middle Aged
• Sach-SW: Neoplasm Grading
• Sach-SW: Neoplasm Invasiveness
• Sach-SW: Pancreatic Ducts
• Sach-SW: Prospective Studies
• Sach-SW: Risk Factors
• Sach-SW: Treatment Outcome
• K10plus-PPN: 174452971X

Abstract

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.