IPMN Involving the Main Pancreatic Duct: Biology, Epidemiology, and Long-term Outcomes Following Resection

Giovanni Marchegiani, Mari Mino-Kenudson, Klaus Sahora, Vicente Morales-Oyarvide, Sarah Thayer, Cristina Ferrone, Andrew L. Warshaw, Keith D. Lillemoe, Carlos Fernández Del Castillo

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Objectives: To describe the characteristics of intraductal papillary mucinous neoplasms (IPMNs) with predominant involvement of the main pancreatic duct (MPD), analyzing predictors for survival and recurrence. Background: IPMNs involving the MPD harbor a high likelihood of malignancy and different biological features. The appropriateness of including cases with minimal noncircumferential MPD involvement has been challenged because these show clinicopathological features that are similar to branch duct IPMN. Accordingly, their exclusion has led to a redefinition of MPD IPMN (MD-IPMN). Methods: Retrospective review of resected MD-IPMN from 1990 to 2013. All slides were reviewed by a single pancreatic pathologist and classified on the basis of epithelial type and invasive component. Results: A total of 223 patients underwent resection for IPMN involving the MPD. Of these, 50 were excluded because of minimal MPD involvement. Among the 173 patients analyzed, median age was 68 years and 55% were males. Predominant epithelial phenotype was intestinal (50%). Forty-eight patients (28%) had low-or intermediate-grade dysplasia, whereas 125 (72%) had either high-grade dysplasia (33%) or invasive carcinoma (39%). Of the 67 invasive IPMNs, 39 were tubular carcinomas (58%) and invasion was minimal (<5 mm) in 28 (42%). The 5-year overall survival rate was 69% and the disease-specific survival rate was 83%. The estimated recurrence rate at 10 years was 25%. Size and type of the invasive component, lymph node positivity, and a positive resection margin were predictors for both survival and recurrence (P < 0.05). Conclusions: MD-IPMN is mainly intestinal-type and malignant. After resection, it has a very favorable prognosis, especially in the absence of macroscopic invasive carcinoma.

Original languageEnglish (US)
Pages (from-to)976-983
Number of pages8
JournalAnnals of surgery
Volume261
Issue number5
DOIs
StatePublished - May 1 2015

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Pancreatic Ducts
Epidemiology
Neoplasms
Recurrence
Survival Rate
Carcinoma
Survival
Adenocarcinoma
Lymph Nodes
Phenotype

Keywords

  • IPMN
  • MD-IPMN
  • cystic neoplasm
  • intraductal papillary mucinous neoplasm
  • pancreas

ASJC Scopus subject areas

  • Surgery

Cite this

Marchegiani, G., Mino-Kenudson, M., Sahora, K., Morales-Oyarvide, V., Thayer, S., Ferrone, C., ... Castillo, C. F. D. (2015). IPMN Involving the Main Pancreatic Duct: Biology, Epidemiology, and Long-term Outcomes Following Resection. Annals of surgery, 261(5), 976-983. https://doi.org/10.1097/SLA.0000000000000813

IPMN Involving the Main Pancreatic Duct : Biology, Epidemiology, and Long-term Outcomes Following Resection. / Marchegiani, Giovanni; Mino-Kenudson, Mari; Sahora, Klaus; Morales-Oyarvide, Vicente; Thayer, Sarah; Ferrone, Cristina; Warshaw, Andrew L.; Lillemoe, Keith D.; Castillo, Carlos Fernández Del.

In: Annals of surgery, Vol. 261, No. 5, 01.05.2015, p. 976-983.

Research output: Contribution to journalArticle

Marchegiani, G, Mino-Kenudson, M, Sahora, K, Morales-Oyarvide, V, Thayer, S, Ferrone, C, Warshaw, AL, Lillemoe, KD & Castillo, CFD 2015, 'IPMN Involving the Main Pancreatic Duct: Biology, Epidemiology, and Long-term Outcomes Following Resection', Annals of surgery, vol. 261, no. 5, pp. 976-983. https://doi.org/10.1097/SLA.0000000000000813
Marchegiani, Giovanni ; Mino-Kenudson, Mari ; Sahora, Klaus ; Morales-Oyarvide, Vicente ; Thayer, Sarah ; Ferrone, Cristina ; Warshaw, Andrew L. ; Lillemoe, Keith D. ; Castillo, Carlos Fernández Del. / IPMN Involving the Main Pancreatic Duct : Biology, Epidemiology, and Long-term Outcomes Following Resection. In: Annals of surgery. 2015 ; Vol. 261, No. 5. pp. 976-983.
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abstract = "Objectives: To describe the characteristics of intraductal papillary mucinous neoplasms (IPMNs) with predominant involvement of the main pancreatic duct (MPD), analyzing predictors for survival and recurrence. Background: IPMNs involving the MPD harbor a high likelihood of malignancy and different biological features. The appropriateness of including cases with minimal noncircumferential MPD involvement has been challenged because these show clinicopathological features that are similar to branch duct IPMN. Accordingly, their exclusion has led to a redefinition of MPD IPMN (MD-IPMN). Methods: Retrospective review of resected MD-IPMN from 1990 to 2013. All slides were reviewed by a single pancreatic pathologist and classified on the basis of epithelial type and invasive component. Results: A total of 223 patients underwent resection for IPMN involving the MPD. Of these, 50 were excluded because of minimal MPD involvement. Among the 173 patients analyzed, median age was 68 years and 55{\%} were males. Predominant epithelial phenotype was intestinal (50{\%}). Forty-eight patients (28{\%}) had low-or intermediate-grade dysplasia, whereas 125 (72{\%}) had either high-grade dysplasia (33{\%}) or invasive carcinoma (39{\%}). Of the 67 invasive IPMNs, 39 were tubular carcinomas (58{\%}) and invasion was minimal (<5 mm) in 28 (42{\%}). The 5-year overall survival rate was 69{\%} and the disease-specific survival rate was 83{\%}. The estimated recurrence rate at 10 years was 25{\%}. Size and type of the invasive component, lymph node positivity, and a positive resection margin were predictors for both survival and recurrence (P < 0.05). Conclusions: MD-IPMN is mainly intestinal-type and malignant. After resection, it has a very favorable prognosis, especially in the absence of macroscopic invasive carcinoma.",
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AU - Mino-Kenudson, Mari

AU - Sahora, Klaus

AU - Morales-Oyarvide, Vicente

AU - Thayer, Sarah

AU - Ferrone, Cristina

AU - Warshaw, Andrew L.

AU - Lillemoe, Keith D.

AU - Castillo, Carlos Fernández Del

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N2 - Objectives: To describe the characteristics of intraductal papillary mucinous neoplasms (IPMNs) with predominant involvement of the main pancreatic duct (MPD), analyzing predictors for survival and recurrence. Background: IPMNs involving the MPD harbor a high likelihood of malignancy and different biological features. The appropriateness of including cases with minimal noncircumferential MPD involvement has been challenged because these show clinicopathological features that are similar to branch duct IPMN. Accordingly, their exclusion has led to a redefinition of MPD IPMN (MD-IPMN). Methods: Retrospective review of resected MD-IPMN from 1990 to 2013. All slides were reviewed by a single pancreatic pathologist and classified on the basis of epithelial type and invasive component. Results: A total of 223 patients underwent resection for IPMN involving the MPD. Of these, 50 were excluded because of minimal MPD involvement. Among the 173 patients analyzed, median age was 68 years and 55% were males. Predominant epithelial phenotype was intestinal (50%). Forty-eight patients (28%) had low-or intermediate-grade dysplasia, whereas 125 (72%) had either high-grade dysplasia (33%) or invasive carcinoma (39%). Of the 67 invasive IPMNs, 39 were tubular carcinomas (58%) and invasion was minimal (<5 mm) in 28 (42%). The 5-year overall survival rate was 69% and the disease-specific survival rate was 83%. The estimated recurrence rate at 10 years was 25%. Size and type of the invasive component, lymph node positivity, and a positive resection margin were predictors for both survival and recurrence (P < 0.05). Conclusions: MD-IPMN is mainly intestinal-type and malignant. After resection, it has a very favorable prognosis, especially in the absence of macroscopic invasive carcinoma.

AB - Objectives: To describe the characteristics of intraductal papillary mucinous neoplasms (IPMNs) with predominant involvement of the main pancreatic duct (MPD), analyzing predictors for survival and recurrence. Background: IPMNs involving the MPD harbor a high likelihood of malignancy and different biological features. The appropriateness of including cases with minimal noncircumferential MPD involvement has been challenged because these show clinicopathological features that are similar to branch duct IPMN. Accordingly, their exclusion has led to a redefinition of MPD IPMN (MD-IPMN). Methods: Retrospective review of resected MD-IPMN from 1990 to 2013. All slides were reviewed by a single pancreatic pathologist and classified on the basis of epithelial type and invasive component. Results: A total of 223 patients underwent resection for IPMN involving the MPD. Of these, 50 were excluded because of minimal MPD involvement. Among the 173 patients analyzed, median age was 68 years and 55% were males. Predominant epithelial phenotype was intestinal (50%). Forty-eight patients (28%) had low-or intermediate-grade dysplasia, whereas 125 (72%) had either high-grade dysplasia (33%) or invasive carcinoma (39%). Of the 67 invasive IPMNs, 39 were tubular carcinomas (58%) and invasion was minimal (<5 mm) in 28 (42%). The 5-year overall survival rate was 69% and the disease-specific survival rate was 83%. The estimated recurrence rate at 10 years was 25%. Size and type of the invasive component, lymph node positivity, and a positive resection margin were predictors for both survival and recurrence (P < 0.05). Conclusions: MD-IPMN is mainly intestinal-type and malignant. After resection, it has a very favorable prognosis, especially in the absence of macroscopic invasive carcinoma.

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