Advertisement

Surgical Management of IPMN

  • Stefano Crippa
  • Carlos Fernandez-del Castillo
  • Andrew L. Warshaw
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Once considered as a “rare” entity, intraductal papillary mucinous neoplasm (IPMN) of the pancreas is nowadays more commonly recognized, thanks to the widespread use of cross-sectioning imaging techniques (1, 2). At our institution, IPMN has become the second most common indication for pancreatic resection, following ductal adenocarcinoma.

Since its first description by Ohashi in 1982, knowledge of the clinical, radiologic, and pathologic characteristics of IPMN has increased rapidly ( 3 ). Several series have documented the prevalence of malignancy and the risk of tumor recurrence after surgical resection among these patients. However, much of the natural history of IPMN still remains unknown.

In 2000 the World Health Organization (WHO) divided IPMN into two different entities: main-duct and branch-duct IPMN. Main-duct IPMNs are characterized by involvement of the main pancreatic duct with or without associated involvement of the branch ducts (combined IPMNs) ( 2 ). They commonly present with a dilated (≤1 cm) main pancreatic duct full of mucus that may extrude through a bulging ampulla. Some have cystic dilation of the main pancreatic duct ( 4 ). Main-duct IPMNs are usually located in the proximal portion of the gland, but can spread longitudinally along the duct, even to involve the entire main pancreatic duct. Patients affected by main-duct IPMN may present with abdominal pain, pancreatitis, steatorrhea, and weight loss. Diabetes is indicative of late-stage deterioration, and jaundice commonly indicates malignant degeneration ( 58 ).

Keywords

Main Pancreatic Duct Intraductal Papillary Mucinous Neoplasm Total Pancreatectomy Main Duct Mural Nodule 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Carbognin G, Zamboni G, Pinali L, 2006, Branch duct IPMTs: value of cross-sectional imaging in the assessment of biological behavior and follow-up. Abdom Imaging 31: 320–325.CrossRefPubMedGoogle Scholar
  2. 2.
    Tanaka M, Chari S, Adsay V, 2005, International Consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6:17–32.CrossRefGoogle Scholar
  3. 3.
    Ohashi K, Murakami Y, Murayama M, 1982, Four cases of mucus secreting pancreatic cancer. Prog Dig Endoscopy 20:348–351.Google Scholar
  4. 4.
    Lim JH, Lee G, Oh YL, 2001, Radiologic spectrum of intraductal papillary mucinous tumor of the pancreas. Radiographics 21: 323–340.PubMedGoogle Scholar
  5. 5.
    Falconi M, Salvia R, Bassi C, 2001, Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg 88:376–381.CrossRefPubMedGoogle Scholar
  6. 6.
    Sohn TA, Yeo CJ, Cameron JL, 2004, Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239:788–797.CrossRefPubMedGoogle Scholar
  7. 7.
    Salvia R, Fernandez-del Castillo C, Bassi C, 2004, Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 239:678–685.CrossRefPubMedGoogle Scholar
  8. 8.
    Chari ST, Yadav D, Smyrk TC, 2002, Study of recurrence after surgical resection of intraduc-tal papillary mucinous neoplasm of the pancreas. Gastroenterology 123: 1500–1507.CrossRefPubMedGoogle Scholar
  9. 9.
    Kobari M, Egawa S, Shibuya K, 1999, Intraductal papillary mucinous tumors of the pancreas comprise 2 clinical subtypes: differences in clinical characteristics and surgical management. Arch Surg 134:1131–1136.CrossRefPubMedGoogle Scholar
  10. 10.
    Terris B, Ponsot P, Paye F, 2000, Intraductal papillary mucinous tumors of the pancreas con-fined to secondary ducts show less aggressive pathologic features as compared with those involving the main pancreatic duct. Am J Surg Pathol 24: 1372–1377.CrossRefPubMedGoogle Scholar
  11. 11.
    Sugiyama M, Izumisato Y, Abe N, 2003, Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 90:1244–1249.CrossRefPubMedGoogle Scholar
  12. 12.
    Balcom JH, 4th Rattner DW, Warshaw AL, 2001, Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136:391–398.CrossRefPubMedGoogle Scholar
  13. 13.
    Wada K, Takada T, Yasuda H, 2004, Does “clonal progression” relate to the development of intraductal papillary mucinous tumors of the pancreas? J Gastrointest Surg 8:289–296.CrossRefPubMedGoogle Scholar
  14. 14.
    Brugge WR, Lauwers GY, Sahani D, 2004, Cystic neoplasms of the pancreas. N Engl J Med 351:1218–1226.CrossRefPubMedGoogle Scholar
  15. 15.
    Nichols MT, Russ PD, Chen YK, 2006, Pancreatic imaging. Current and emerging techniques. Pancreas 33:211–220.CrossRefGoogle Scholar
  16. 16.
    Sahani DV, Kadavigere R, Blake M, 2006, Intraductal papillary mucinous neoplasm of pancreas: multi-detector row CT with 2D curved reformations—correlation with MRCP. Radiology 238:560–569.CrossRefPubMedGoogle Scholar
  17. 17.
    Pilleul F, Rochette A, Partensky C, 2005, Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 21: 237–244.CrossRefPubMedGoogle Scholar
  18. 18.
    Stelow EB, Stanley MW, Bardales RH, 2003, Intraductal papillary-mucinous neoplasm of the pancreas. The findings and limitations of cytologic samples obtained by endoscopic ultra-sound-guided fine-needle aspiration. Am J Clin Pathol 120:398–404.CrossRefPubMedGoogle Scholar
  19. 19.
    Brugge WR, Lewandrowski K, Lee-Lewandrowski E, 2004, Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology 126:1330–1336.CrossRefPubMedGoogle Scholar
  20. 20.
    Sperti C, Pasquali C, Decet G, 2005, F-18-fluorodeoxyglucose positron emission tomography in differentiating malignant from benign pancreatic cysts: a prospective study. J Gastrointest Surg 9:22–28.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaneko T, Nakao A, Nomoto S, 1998, Intraoperative pancreatoscopy with the ultrathin pan-creatoscope for mucin-producing tumors of the pancreas. Arch Surg 133:263–267.CrossRefPubMedGoogle Scholar
  22. 22.
    Gigot JF, Deprez P, Sempoux C, 2001, Surgical management of intraductal papillary muci-nous tumors of the pancreas: the role of routine frozen section of the surgical margin, intraoperative endoscopic staged biopsies of the Wirsung duct, and pancreaticogastric anastomosis. Arch Surg 136:1256–1262.CrossRefPubMedGoogle Scholar
  23. 23.
    Sauvanet A, Partensky C, Sastre B, 2002, Medial pancreatectomy: a multi-institutional retrospective study of 53 patients by the French Pancreas Club. Surgery 132: 836–843.CrossRefPubMedGoogle Scholar
  24. 24.
    Thayer SP, Fernandez-del Castillo C, Balcom JH, 2002, Complete dorsal pancreatectomy with preservation of the ventral pancreas: a new surgical technique Surgery 131: 577–580.CrossRefPubMedGoogle Scholar
  25. 25.
    Couvelard A, Sauvanet A, Kianmanesh R, 2005, Frozen sectioning of the pancreatic cut surface during resection of intraductal papillary mucinous neoplasms of the pancreas is useful and reliable. A prospective evaluation. Ann Surg 242:774–780.CrossRefPubMedGoogle Scholar
  26. 26.
    Eguchi H, Ishikawa O, Ohigashi H, 2006, Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillarymucinous carcinoma of the pancreas. Cancer 107:2567–2575.CrossRefPubMedGoogle Scholar
  27. 27.
    Jang JY, Kim SW, Ahn YJ, 2005, Multicenter analysis of clinicopathologic features of intra-ductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol 12: 124–132.CrossRefPubMedGoogle Scholar
  28. 28.
    Maire F, Hammel P, Terris B, 2002, Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocar-cinoma. Gut 51:717–722.CrossRefPubMedGoogle Scholar
  29. 29.
    Bassi C, Butturini G, Salvia R, 2006, Open pancreaticogastrostomy after pancreaticoduo-denectomy: a pilot study. J Gastrointest Surg 10:1072–1080.CrossRefPubMedGoogle Scholar
  30. 30.
    Salvia R, Crippa S, Falconi M, 2007, Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Results of a prospective protocol on the manage-ment of 109 consecutive patients. Gut 56:1086–1090.CrossRefPubMedGoogle Scholar
  31. 31.
    Rodriguez JR, Salvia R, Crippa S, 2007, Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 133: 72–79.CrossRefPubMedGoogle Scholar
  32. 32.
    Wada K, Kozarek RA, Traverso LW, 2005, Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas. Am J Surg 189: 632–637.CrossRefPubMedGoogle Scholar
  33. 33.
    D’Angelica M, Brennan MF, Suriawinata AA, 2004, Intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 239:400–408.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Stefano Crippa
    • 1
  • Carlos Fernandez-del Castillo
    • 1
  • Andrew L. Warshaw
    • 1
  1. 1.Harvard Medical SchoolMassachusetts General HospitalBostonUSA

Personalised recommendations