Abstract
Intraductal papillary mucinous neoplasm (IPMN) comprises a spectrum of mucin-producing cystic neoplasms of pancreatic ductal origin that range from benign adenoma to invasive carcinoma. The 2012 Updated Consensus Guidelines recommend resection of all main duct IPMN (MD-IPMN) with a main pancreatic duct diameter of ≥10 mm, and for branch duct IPMN (BD-IPMN) with high-risk stigmata. These broad categories include many patients who do not harbor an invasive carcinoma, and additional investigations such as cyst fluid analysis, pancreatic juice cytology or FNA of associated solid components may be employed to further characterize the malignant nature of an asymptomatic IPMN. There are limited data on the natural history of patients falling within resection criteria who do not undergo surgery, but the available studies suggest comparable disease-specific and overall survivals in older patients who are managed with observation/surveillance versus resection. Mortality for major pancreatic resection is 0–4 % in high-volume centers, and morbidity ranges from 16 % to 53 %, both of which are increased in patients >70 years old. Quality of life data extrapolated from non-IPMN post-pancreatectomy patients suggests that most domains return to preoperative levels within 3 months, and that malignancy is associated with poor quality of life at 2 years. Non-operative management of IPMN meeting resection criteria may be appropriate for select older patients based on co-morbidities or patient preference.
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References
Tanaka M, Fernandez-del Castillo C, Adsay V, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatol: Off J Int Assoc Pancreatol. 2012;12:183–97.
Roch AM, DeWitt JM, Al-Haddad MA, et al. Nonoperative management of main pancreatic duct-involved intraductal papillary mucinous neoplasm might be indicated in select patients. J Am Coll Surg. 2014;219:122–9.
Abdeljawad K, Vemulapalli KC, Schmidt CM, et al. Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms. Gastrointest Endosc. 2014;79:623–9.
Aso T, Ohtsuka T, Matsunaga T, et al. “High-Risk Stigmata” of the 2012 international consensus guidelines correlate with the malignant grade of branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas. 2014; 43(8):1239–43.
Correa-Gallego C, Do R, Lafemina J, et al. Predicting dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas: development of a preoperative nomogram. Ann Surg Oncol. 2013;20:4348–55.
Marchegiani G, Mino-Kenudson M, Sahora K, et al. IPMN involving the main pancreatic duct: Biology, epidemiology, and long-term outcomes following resection. Ann Surg. 2015; 261(5):976–83.
Shimizu Y, Yamaue H, Maguchi H, et al. Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas. 2013;42:883–8.
Fritz S, Klauss M, Bergmann F, et al. Small (Sendai negative) branch-duct IPMNs: not harmless. Ann Surg. 2012;256:313–20.
Wong J, Weber J, Centeno BA, et al. High-grade dysplasia and adenocarcinoma are frequent in side-branch intraductal papillary mucinous neoplasm measuring less than 3 cm on endoscopic ultrasound. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2013;17:78–84. discussion p -5.
Are C, Afuh C, Ravipati L, Sasson A, Ullrich F, Smith L. Preoperative nomogram to predict risk of perioperative mortality following pancreatic resections for malignancy. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2009;13:2152–62.
Haigh PI, Bilimoria KY, DiFronzo LA. Early postoperative outcomes after pancreaticoduodenectomy in the elderly. Arch Surg. 2011;146:715–23.
Makary MA, Winter JM, Cameron JL, et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2006;10:347–56.
Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc. 2008;22:1334–8.
Kooby DA, Gillespie T, Bentrem D, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438–46.
Velanovich V. Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2006;10:95–8.
Vijan SS, Ahmed KA, Harmsen WS, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg. 2010;145:616–21.
Salvia R, Fernandez-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239:678–85. discussion 85-7.
Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239:788–97. discussion 97-9.
Parikh P, Shiloach M, Cohen ME, et al. Pancreatectomy risk calculator: an ACS-NSQIP resource. HPB: Off J Int Hepato Pancreato Biliary Assoc. 2010;12:488–97.
Waters JA, Schnelldorfer T, Aguilar-Saavedra JR, et al. Survival after resection for invasive intraductal papillary mucinous neoplasm and for pancreatic adenocarcinoma: a multi-institutional comparison according to American Joint Committee on Cancer Stage. J Am Coll Surg. 2011;213:275–83.
Kang MJ, Jang JY, Lee KB, Chang YR, Kwon W, Kim SW. Long-term prospective cohort study of patients undergoing pancreatectomy for intraductal papillary mucinous neoplasm of the pancreas: Implications for postoperative surveillance. Ann Surg. 2014; 260(2):356–63.
Nakagohri T, Kinoshita T, Konishi M, Takahashi S, Gotohda N. Surgical outcome of intraductal papillary mucinous neoplasms of the pancreas. Ann Surg Oncol. 2007;14:3174–80.
Distler M, Kersting S, Niedergethmann M, et al. Pathohistological subtype predicts survival in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Surg. 2013;258:324–30.
Kawakubo K, Tada M, Isayama H, et al. Disease-specific mortality among patients with intraductal papillary mucinous neoplasm of the pancreas. Clin Gastroenterol Hepatol: Off Clin Pract J Am Gastroenterol Assoc. 2014;12:486–91.
Takuma K, Kamisawa T, Anjiki H, et al. Predictors of malignancy and natural history of main-duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas. 2011;40:371–5.
Ogura T, Masuda D, Kurisu Y, et al. Potential predictors of disease progression for main-duct intraductal papillary mucinous neoplasms of the pancreas. J Gastroenterol Hepatol. 2013;28:1782–6.
Piciucchi M, Crippa S, Del Chiaro M, et al. Outcomes of intraductal papillary mucinous neoplasm with “Sendai-positive” criteria for resection undergoing non-operative management. Dig Liver Dis: Off J Ital Soc Gastroenterol Ital Assoc Stud Liver. 2013;45:584–8.
Uehara H, Ishikawa O, Ikezawa K, et al. A natural course of main duct intraductal papillary mucinous neoplasm of the pancreas with lower likelihood of malignancy. Pancreas. 2010;39:653–7.
Lee MK, DiNorcia J, Pursell LJ, et al. Prophylactic pancreatectomy for intraductal papillary mucinous neoplasm does not negatively impact quality of life: a preliminary study. J Gastrointest Surg: Off J Soc Surg Aliment Tract. 2010;14:1847–52.
Belyaev O, Herzog T, Chromik AM, Meurer K, Uhl W. Early and late postoperative changes in the quality of life after pancreatic surgery. Langenbeck’s Arch Surg/Deut Ges Chir. 2013;398:547–55.
Park JW, Jang JY, Kim EJ, et al. Effects of pancreatectomy on nutritional state, pancreatic function and quality of life. Br J Surg. 2013;100:1064–70.
Sahora K, Mino-Kenudson M, Brugge W, et al. Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg. 2013;258:466–75.
Roch AM, Ceppa EP, Al-Haddad MA, et al. The natural history of main duct-involved, mixed-type intraductal papillary mucinous neoplasm: parameters predictive of progression. Ann Surg. 2014;260:680–90.
Wang SE, Shyr YM, Chen TH, et al. Comparison of resected and non-resected intraductal papillary mucinous neoplasms of the pancreas. World J Surg. 2005;29:1650–7.
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Brown, K.M. (2016). Management of Asymptomatic IPMN in the Elderly. In: Millis, J., Matthews, J. (eds) Difficult Decisions in Hepatobiliary and Pancreatic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-319-27365-5_47
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DOI: https://doi.org/10.1007/978-3-319-27365-5_47
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