Rachel E Simpson1, Eugene P Ceppa1,2, Howard H Wu3, Fatih Akisik4, Michael G House1, Nicholas J Zyromski1, Attila Nakeeb1, Mohammad A Al-Haddad2,5, John M DeWitt5, Stuart Sherman5, C Max Schmidt6,7,8,9,10. 1. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 129, Indianapolis, IN, 46202, USA. 2. Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA. 3. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. 4. Department of Radiology, Indiana University School of Medicine, Indianapolis, IN, USA. 5. Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN, USA. 6. Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, Emerson Hall 129, Indianapolis, IN, 46202, USA. maxschmi@iupui.edu. 7. Indiana University Health Pancreatic Cyst and Cancer Early Detection Center, Indianapolis, IN, USA. maxschmi@iupui.edu. 8. Department of Biochemistry/Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA. maxschmi@iupui.edu. 9. Walther Oncology Center, Indianapolis, IN, USA. maxschmi@iupui.edu. 10. Indiana University Simon Cancer Center, Indianapolis, IN, USA. maxschmi@iupui.edu.
Abstract
OBJECTIVE(S): A dilated main pancreatic duct in the distal remnant after proximal pancreatectomy for intraductal papillary mucinous neoplasms (IPMN) poses a diagnostic dilemma. We sought to determine parameters predictive of remnant main-duct IPMN and malignancy during surveillance. METHODS: Three hundred seventeen patients underwent proximal pancreatectomy for IPMN (Indiana University, 1991-2016). Main-duct dilation included those ≥ 5 mm or "dilated" on radiographic reports. Statistics compared groups using Student's T/Mann-Whitney U tests for continuous variables or chi-square/Fisher's exact test for categorical variables with P < 0.05 considered significant. RESULTS: High-grade/invasive IPMN or adenocarcinoma at proximal pancreatectomy predicted malignant outcomes (100.0% malignant outcomes; P < 0.001) in remnant surveillance. Low/moderate-grade lesions revealed benign outcomes at last surveillance regardless of duct diameter. Twenty of 21 patients undergoing distal remnant reoperation had a dilated main duct. Seven had main-duct IPMN on remnant pathology; these patients had greater mean maximum main-duct diameter prior to reoperation (9.5 vs 6.2 mm, P = 0.072), but this did not reach statistical significance. Several features showed high sensitivity/specificity for remnant main-duct IPMN. CONCLUSIONS: Remnant main-duct dilation after proximal pancreatectomy for IPMN remains a diagnostic dilemma. Several parameters show a promise in accurately diagnosing main-duct IPMN in the remnant.
OBJECTIVE(S): A dilated main pancreatic duct in the distal remnant after proximal pancreatectomy for intraductal papillary mucinous neoplasms (IPMN) poses a diagnostic dilemma. We sought to determine parameters predictive of remnant main-duct IPMN and malignancy during surveillance. METHODS: Three hundred seventeen patients underwent proximal pancreatectomy for IPMN (Indiana University, 1991-2016). Main-duct dilation included those ≥ 5 mm or "dilated" on radiographic reports. Statistics compared groups using Student's T/Mann-Whitney U tests for continuous variables or chi-square/Fisher's exact test for categorical variables with P < 0.05 considered significant. RESULTS: High-grade/invasive IPMN or adenocarcinoma at proximal pancreatectomy predicted malignant outcomes (100.0% malignant outcomes; P < 0.001) in remnant surveillance. Low/moderate-grade lesions revealed benign outcomes at last surveillance regardless of duct diameter. Twenty of 21 patients undergoing distal remnant reoperation had a dilated main duct. Seven had main-duct IPMN on remnant pathology; these patients had greater mean maximum main-duct diameter prior to reoperation (9.5 vs 6.2 mm, P = 0.072), but this did not reach statistical significance. Several features showed high sensitivity/specificity for remnant main-duct IPMN. CONCLUSIONS: Remnant main-duct dilation after proximal pancreatectomy for IPMN remains a diagnostic dilemma. Several parameters show a promise in accurately diagnosing main-duct IPMN in the remnant.
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