Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection

J. Ruben Rodriguez, Roberto Salvia, Stefano Crippa, Andrew L. Warshaw, Claudio Bassi, Massimo Falconi, Sarah P. Thayer, Gregory Y. Lauwers, Paola Capelli, Mari Mino-Kenudson, Oswaldo Razo, Deborah McGrath, Paolo Pederzoli, Carlos Fernández-Del Castillo

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Abstract

Background & Aims: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas arising in branch ducts are thought to be less aggressive than their main-duct counterparts, and guidelines for their conservative management were recently proposed. This study describes the combined experience of 2 tertiary centers with branch-duct IPMNs aiming to validate these recommendations. Methods: A review of 145 patients with resected, pathologically confirmed, branch-duct IPMNs between 1990 and 2005 was conducted. Results: Sixty-six patients (45.5%) had adenoma, 47 (32%) borderline tumors, 16 (11%) carcinoma in situ, and 16 (11%) invasive carcinoma. Median age was similar between benign and malignant subgroups (66 vs 67.5 years, respectively). Jaundice was more frequent in patients with cancer (12.5% vs 1.8%, respectively, P = .022) and abdominal pain in patients with benign tumors (45% vs 25%, respectively, P = .025). Forty percent of tumors were discovered incidentally. Findings associated with malignancy were the presence of a thick wall (P < .001), nodules (P < .001), and tumor diameter ≥30 mm (P < .001). All neoplasms with cancer were larger than 30 mm in size or had nodules or caused symptoms. After a mean follow-up of 45 months, the 5-year disease-specific survival for branch-duct IPMNs with noninvasive neoplasms was 100% and, for invasive cancer, was 63%. Conclusions: This large cohort of resected branch-duct IPMNs shows that cancer is present in 22% of cases and validates the recent guidelines that indicate absence of malignancy in tumors <30 mm, without symptoms or mural nodules.

Original languageEnglish (US)
Pages (from-to)72-79
Number of pages8
JournalGastroenterology
Volume133
Issue number1
DOIs
StatePublished - Jun 2007

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Neoplasms
Guidelines
Carcinoma in Situ
Jaundice
Pancreatic Neoplasms
Adenoma
Abdominal Pain
Carcinoma
Survival

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Rodriguez, J. R., Salvia, R., Crippa, S., Warshaw, A. L., Bassi, C., Falconi, M., ... Fernández-Del Castillo, C. (2007). Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection. Gastroenterology, 133(1), 72-79. https://doi.org/10.1053/j.gastro.2007.05.010

Branch-Duct Intraductal Papillary Mucinous Neoplasms : Observations in 145 Patients Who Underwent Resection. / Rodriguez, J. Ruben; Salvia, Roberto; Crippa, Stefano; Warshaw, Andrew L.; Bassi, Claudio; Falconi, Massimo; Thayer, Sarah P.; Lauwers, Gregory Y.; Capelli, Paola; Mino-Kenudson, Mari; Razo, Oswaldo; McGrath, Deborah; Pederzoli, Paolo; Fernández-Del Castillo, Carlos.

In: Gastroenterology, Vol. 133, No. 1, 06.2007, p. 72-79.

Research output: Contribution to journalArticle

Rodriguez, JR, Salvia, R, Crippa, S, Warshaw, AL, Bassi, C, Falconi, M, Thayer, SP, Lauwers, GY, Capelli, P, Mino-Kenudson, M, Razo, O, McGrath, D, Pederzoli, P & Fernández-Del Castillo, C 2007, 'Branch-Duct Intraductal Papillary Mucinous Neoplasms: Observations in 145 Patients Who Underwent Resection', Gastroenterology, vol. 133, no. 1, pp. 72-79. https://doi.org/10.1053/j.gastro.2007.05.010
Rodriguez, J. Ruben ; Salvia, Roberto ; Crippa, Stefano ; Warshaw, Andrew L. ; Bassi, Claudio ; Falconi, Massimo ; Thayer, Sarah P. ; Lauwers, Gregory Y. ; Capelli, Paola ; Mino-Kenudson, Mari ; Razo, Oswaldo ; McGrath, Deborah ; Pederzoli, Paolo ; Fernández-Del Castillo, Carlos. / Branch-Duct Intraductal Papillary Mucinous Neoplasms : Observations in 145 Patients Who Underwent Resection. In: Gastroenterology. 2007 ; Vol. 133, No. 1. pp. 72-79.
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abstract = "Background & Aims: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas arising in branch ducts are thought to be less aggressive than their main-duct counterparts, and guidelines for their conservative management were recently proposed. This study describes the combined experience of 2 tertiary centers with branch-duct IPMNs aiming to validate these recommendations. Methods: A review of 145 patients with resected, pathologically confirmed, branch-duct IPMNs between 1990 and 2005 was conducted. Results: Sixty-six patients (45.5{\%}) had adenoma, 47 (32{\%}) borderline tumors, 16 (11{\%}) carcinoma in situ, and 16 (11{\%}) invasive carcinoma. Median age was similar between benign and malignant subgroups (66 vs 67.5 years, respectively). Jaundice was more frequent in patients with cancer (12.5{\%} vs 1.8{\%}, respectively, P = .022) and abdominal pain in patients with benign tumors (45{\%} vs 25{\%}, respectively, P = .025). Forty percent of tumors were discovered incidentally. Findings associated with malignancy were the presence of a thick wall (P < .001), nodules (P < .001), and tumor diameter ≥30 mm (P < .001). All neoplasms with cancer were larger than 30 mm in size or had nodules or caused symptoms. After a mean follow-up of 45 months, the 5-year disease-specific survival for branch-duct IPMNs with noninvasive neoplasms was 100{\%} and, for invasive cancer, was 63{\%}. Conclusions: This large cohort of resected branch-duct IPMNs shows that cancer is present in 22{\%} of cases and validates the recent guidelines that indicate absence of malignancy in tumors <30 mm, without symptoms or mural nodules.",
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T2 - Observations in 145 Patients Who Underwent Resection

AU - Rodriguez, J. Ruben

AU - Salvia, Roberto

AU - Crippa, Stefano

AU - Warshaw, Andrew L.

AU - Bassi, Claudio

AU - Falconi, Massimo

AU - Thayer, Sarah P.

AU - Lauwers, Gregory Y.

AU - Capelli, Paola

AU - Mino-Kenudson, Mari

AU - Razo, Oswaldo

AU - McGrath, Deborah

AU - Pederzoli, Paolo

AU - Fernández-Del Castillo, Carlos

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N2 - Background & Aims: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas arising in branch ducts are thought to be less aggressive than their main-duct counterparts, and guidelines for their conservative management were recently proposed. This study describes the combined experience of 2 tertiary centers with branch-duct IPMNs aiming to validate these recommendations. Methods: A review of 145 patients with resected, pathologically confirmed, branch-duct IPMNs between 1990 and 2005 was conducted. Results: Sixty-six patients (45.5%) had adenoma, 47 (32%) borderline tumors, 16 (11%) carcinoma in situ, and 16 (11%) invasive carcinoma. Median age was similar between benign and malignant subgroups (66 vs 67.5 years, respectively). Jaundice was more frequent in patients with cancer (12.5% vs 1.8%, respectively, P = .022) and abdominal pain in patients with benign tumors (45% vs 25%, respectively, P = .025). Forty percent of tumors were discovered incidentally. Findings associated with malignancy were the presence of a thick wall (P < .001), nodules (P < .001), and tumor diameter ≥30 mm (P < .001). All neoplasms with cancer were larger than 30 mm in size or had nodules or caused symptoms. After a mean follow-up of 45 months, the 5-year disease-specific survival for branch-duct IPMNs with noninvasive neoplasms was 100% and, for invasive cancer, was 63%. Conclusions: This large cohort of resected branch-duct IPMNs shows that cancer is present in 22% of cases and validates the recent guidelines that indicate absence of malignancy in tumors <30 mm, without symptoms or mural nodules.

AB - Background & Aims: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas arising in branch ducts are thought to be less aggressive than their main-duct counterparts, and guidelines for their conservative management were recently proposed. This study describes the combined experience of 2 tertiary centers with branch-duct IPMNs aiming to validate these recommendations. Methods: A review of 145 patients with resected, pathologically confirmed, branch-duct IPMNs between 1990 and 2005 was conducted. Results: Sixty-six patients (45.5%) had adenoma, 47 (32%) borderline tumors, 16 (11%) carcinoma in situ, and 16 (11%) invasive carcinoma. Median age was similar between benign and malignant subgroups (66 vs 67.5 years, respectively). Jaundice was more frequent in patients with cancer (12.5% vs 1.8%, respectively, P = .022) and abdominal pain in patients with benign tumors (45% vs 25%, respectively, P = .025). Forty percent of tumors were discovered incidentally. Findings associated with malignancy were the presence of a thick wall (P < .001), nodules (P < .001), and tumor diameter ≥30 mm (P < .001). All neoplasms with cancer were larger than 30 mm in size or had nodules or caused symptoms. After a mean follow-up of 45 months, the 5-year disease-specific survival for branch-duct IPMNs with noninvasive neoplasms was 100% and, for invasive cancer, was 63%. Conclusions: This large cohort of resected branch-duct IPMNs shows that cancer is present in 22% of cases and validates the recent guidelines that indicate absence of malignancy in tumors <30 mm, without symptoms or mural nodules.

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