BACKGROUND AND AIM: It has been reported that main duct intraductal papillary mucinous neoplasms are more invasive and have a worse prognosis than branch duct intraductal papillary mucinous neoplasms. Therefore, an aggressive surgical approach has mainly been recommended for all MD-IPMNs. However, the surgical management of BD-IPMNs has been controversial and the consensus guidelines are not specific for an indicator of malignancy in BD-IPMNs. The objective of this study was to determine the proper management and follow-up strategy of BD-IPMNs. METHODS: We monitored and analysed patients with presumed BD-IPMNs between March 1995 and March 2010. RESULT: The mean value of the initial cyst size in all patients with BD-IPMNs was 2.19 cm. Amongst 194 patients with BD-IPMNs, 34 underwent immediate surgical resection, 152 were followed conservatively. Amongst the 152 conservatively managed patients, 18 (11.8%) underwent surgical resection after a median follow-up of 12.7 months (range, 3-48 months). In 132 patients who were managed conservatively without surgery, the mean incremental rate of cyst size growth was 0.0038 cm/month during a median of 30.7 months of follow-up and there were no IPMN-related deaths. CONCLUSION: Amongst patients with BD-IPMNs, about 10% have surgery within approximately 1 year from the time of diagnosis because of the occurrence of new malignant stigmata. Therefore, a conservative approach without surgery and careful follow-up every 3 months or 6 months during the first year after diagnosis can be safely advocated in patients with BD-IPMNs larger than 10mm in size who have no risk factors for malignant IPMNs.
BACKGROUND AND AIM: It has been reported that main duct intraductal papillary mucinous neoplasms are more invasive and have a worse prognosis than branch duct intraductal papillary mucinous neoplasms. Therefore, an aggressive surgical approach has mainly been recommended for all MD-IPMNs. However, the surgical management of BD-IPMNs has been controversial and the consensus guidelines are not specific for an indicator of malignancy in BD-IPMNs. The objective of this study was to determine the proper management and follow-up strategy of BD-IPMNs. METHODS: We monitored and analysed patients with presumed BD-IPMNs between March 1995 and March 2010. RESULT: The mean value of the initial cyst size in all patients with BD-IPMNs was 2.19 cm. Amongst 194 patients with BD-IPMNs, 34 underwent immediate surgical resection, 152 were followed conservatively. Amongst the 152 conservatively managed patients, 18 (11.8%) underwent surgical resection after a median follow-up of 12.7 months (range, 3-48 months). In 132 patients who were managed conservatively without surgery, the mean incremental rate of cyst size growth was 0.0038 cm/month during a median of 30.7 months of follow-up and there were no IPMN-related deaths. CONCLUSION: Amongst patients with BD-IPMNs, about 10% have surgery within approximately 1 year from the time of diagnosis because of the occurrence of new malignant stigmata. Therefore, a conservative approach without surgery and careful follow-up every 3 months or 6 months during the first year after diagnosis can be safely advocated in patients with BD-IPMNs larger than 10mm in size who have no risk factors for malignant IPMNs.
Authors: Wilson T Kwong; Robert D Lawson; Gordon Hunt; Syed M Fehmi; James A Proudfoot; Ronghui Xu; Andrew Giap; Raymond S Tang; Ingrid Gonzalez; Mary L Krinsky; Thomas J Savides Journal: Dig Dis Sci Date: 2015-04-30 Impact factor: 3.199
Authors: Robert D Lawson; Gordon C Hunt; Andrew Q Giap; Mary L Krinsky; Jeff Slezak; Raymond S Tang; Ingrid Gonzalez; Wilson T Kwong; Syed A Fehmi; Thomas J Savides Journal: Ann Gastroenterol Date: 2015 Oct-Dec
Authors: Asma Sultana; Richard Jackson; Gilbert Tim; Emma Bostock; Eftychia E Psarelli; Trevor F Cox; Robert Sutton; Paula Ghaneh; Michael G T Raraty; John P Neoptolemos; Christopher M Halloran Journal: Clin Transl Gastroenterol Date: 2015-12-10 Impact factor: 4.488