Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 7, 2015; 21(9): 2658-2667
Published online Mar 7, 2015. doi: 10.3748/wjg.v21.i9.2658
Outcomes of nonresected main-duct intraductal papillary mucinous neoplasms of the pancreas
Mathieu Daudé, Fabrice Muscari, Camille Buscail, Nicolas Carrère, Philippe Otal, Janick Selves, Louis Buscail, Barbara Bournet
Mathieu Daudé, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France
Fabrice Muscari, Nicolas Carrère, Department of Digestive Surgery, CHU Toulouse Rangueil and Purpan, University of Toulouse, 31059 Toulouse, France
Camille Buscail, Department of Public Health and Epidemiology, CHU Rennes Pontchaillou, University of Rennes, 35033 Rennes, France
Philippe Otal, Department of Radiology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France
Janick Selves, Department of Pathology, CHU Toulouse Purpan, University of Toulouse, 31300 Toulouse, France
Author contributions: Buscail L and Bournet B designed the research; Daudé M, Muscari F, Buscail L, Carrère N, Otal P, Selves J and Bournet B performed the research; Daudé M, Buscail C, Carrère N, Otal P, Selves J and Bournet B collected the data; and Buscail C analyzed the data; Daudé M, Muscari F, Buscail L and Bournet B wrote the paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Louis Buscail, MD, PhD, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 1 avenue Jean Poulhès, TSA 50032, Cedex 9, 31059 Toulouse, France. buscail.l@chu-toulouse.fr
Telephone: +33-5-61323055 Fax: +33-5-61322229
Received: September 4, 2014
Peer-review started: September 4, 2014
First decision: September 27, 2014
Revised: October 12, 2014
Accepted: December 5, 2014
Article in press: December 8, 2014
Published online: March 7, 2015
Abstract

AIM: To compare characteristics and outcomes of resected and nonresected main-duct and mixed intraductal papillary mucinous neoplasms of the pancreas (IPMN).

METHODS: Over a 14-year period, 50 patients who did not undergo surgery for resectable main-duct or mixed IPMN, for reasons of precluding comorbidities, age and/or refusal, were compared with 74 patients who underwent resection to assess differences in rates of survival, recurrence/occurrence of malignancy, and prognostic factors. All study participants had dilatation of the main pancreatic duct by ≥ 5 mm, with or without dilatation of the branch ducts. Some of the nonsurgical patients showed evidence of mucus upon perendoscopic retrograde cholangiopancreatography or endoscopic ultrasound and/or after fine needle aspiration. For the surgical patients, pathologic analysis of resected specimens confirmed a diagnosis of IPMN with involvement of the main pancreatic duct or of both branch ducts as well as the main pancreatic duct. Clinical and biologic follow-ups were conducted for all patients at least annually, through hospitalization or consultation every six months during the first year of follow-up, together with abdominal imaging analysis (magnetic resonance cholangiopancreatography or computed tomography) and, if necessary, endoscopic ultrasound with or without fine needle aspiration.

RESULTS: The overall five-year survival rate of patients who underwent resection was significantly greater than that for the nonsurgical patients (74% vs 58%; P = 0.019). The parameters of age (< 70 years) and absence of a nodule were associated with better survival (P < 0.05); however, the parameters of main pancreatic duct diameter > 10 mm, branch duct diameter > 30 mm, or presence of extra pancreatic cancers did not significantly influence the prognosis. In the nonsurgical patients, pancreatic malignancy occurred in 36% of cases within a mean time of 33 mo (median: 29 mo; range: 8-141 mo). Comparison of the nonsurgical patients who experienced disease progression with those who did not progress showed no significant differences in age, sex, symptoms, subtype of IPMN, or follow-up period; only the size of the main pancreatic duct was significantly different between these two sub-groups, with the nonsurgical patients who experienced progression showing a greater diameter at the time of diagnosis (> 10 mm).

CONCLUSION: Patients unfit for surgery have a 36% greater risk of developing pancreatic malignancy of the main-duct or mixed IPMN within a median of 2.5 years.

Keywords: Main-duct intraductal papillary mucinous neoplasms, Pancreatic surgery, Prognosis, Natural history, Risk of malignancy

Core tip: Recent studies have suggested that main-duct and mixed intraductal papillary mucinous neoplasms (IPMN) of the pancreas can be managed conservatively. We compared two groups of patients with resectable main-duct or mixed IPMN who had or had not undergone surgery. Significantly more patients who underwent the resection procedure survived, compared to the nonsurgical patients. Main-duct or mixed IPMN, when surgery is not possible, is associated with a 36% greater risk of developing pancreatic malignancy within a median time of 2.5 years. Dilatation of the main pancreatic duct is predictive of progression of malignancy.