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Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe?

Cited 121 time in Web of Science Cited 138 time in Scopus
Authors
Jang, Jin-Young; Kim, Sun-Whe; Lee, Seung Eun; Yang, Sung Hoon; Lee, Kuhn Uk; Lee, Young Joo; Kim, Song Chul; Han, Duck Jong; Choi, Dong Wook; Choi, Seong Ho; Heo, Jin Seok; Cho, Baik Hwan; Yu, Hee Chul; Yoon, Dong Sup; Lee, Woo Jung; Lee, Hee-Eun; Kang, Gyeong Hoon; Lee, Jeong Min
Issue Date
2007-10-03
Publisher
Springer Verlag
Citation
Ann Surg Oncol. 2008 ;15(1):199-205.
Keywords
Adenocarcinoma, Mucinous/pathology/*surgeryAdenoma/pathology/*surgeryAdultAgedAged, 80 and overCarcinoma, Pancreatic Ductal/pathology/*surgeryFemaleHumansMaleMiddle AgedNeoplasm InvasivenessNeoplasm Staging*PancreatectomyPancreatic Neoplasms/pathology/*surgery*PancreaticoduodenectomyPrognosisRetrospective StudiesSurvival Rate
Abstract
BACKGROUND: The objectives of this study were to investigate the clinicopathological features of branch intraductal papillary mucinous neoplasm (IPMN) and to determine safe criteria for its observation. Most clinicians agree that surgical resection is required to treat main duct-type IPMN because of its high malignancy rate. However, no definite treatment guideline (with respect to surgery or observation) has been issued on the management of branch duct type IPMN. METHODS: We retrospectively reviewed the clinicopathological data of 138 patients who underwent operations for IPMN between 1993 and 2006 at five institutes in Korea. RESULTS: Of 138 patients (mean age, 60.6 years; 87 men, 51 women), 76 underwent pancreatoduodenectomy, 39 distal pancreatectomy, 4 total pancreatectomy, and 20 limited pancreatic resection. There were 112 benign cases: 47 adenoma, 63 borderline cases, and 26 malignant cases, with 9 of these being noninvasive and 17 invasive. By univariate analysis, tumor size and the presence of a mural nodule were identified as meaningful predictors of malignancy. By receiver operating characteristic curve analysis, a tumor size of >2 cm was found to be the most valuable predictor of malignancy. When cases were classified according to tumor size and the presence of a mural nodule, the malignancy rate for a tumor 2 cm, >25%. CONCLUSIONS: Many branch duct IPMNs are malignant. Surgical treatment is recommended, except in cases that are strongly suspected to be benign or cases that present a high operative risk. Observation is only recommended in patients with a tumor size of
ISSN
1534-4681 (Electronic)
1068-9265 (Print)
Language
English
URI
http://hdl.handle.net/10371/62656
DOI
https://doi.org/10.1245/s10434-007-9603-5
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Appears in Collections:
College of Medicine/School of Medicine (의과대학/대학원)Surgery (외과학전공)Journal Papers (저널논문_외과학전공)
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