H. Ito1, T. Ochiai1, S. Matsumura1, Y. Mitsunori1, A. Aihara1, D. Ban1, A. Kudo1, M. Tanabe1 1Tokyo Medical And Dental University,Heptobiliary And Pancreatic Surgery,Bunkyo-ku, Tokyo, Japan
Introduction:
International consensus guideline for management of Intraductal Papillary Mucinous Neoplasms (IPMN) was revised and published in 2012. Despite widespread acceptance of this guideline, the validity and problem have not been well-studied. We aim to evaluate the clinical utility of this new?guideline with our cases and make clear consensus and controversial points.
Methods:
This is a retrospective study of 105 patients who were consulted for IPMN from Jan 2006 to Oct 2014 at our department. Diagnosis was performed with dynamic enhanced CT and MRI. Pathological analyses were according to Who Classification of Tumours of the Digestive System 4th edition.
Results:
A total of 15 patients undergoing resection for IPMN with new guideline were identified from Apr2013 to Oct 2014. Of these, 11 patients had a component of MD/Mix-IPMN. Carcinoma was found in 5/11(45%) patients and the following were the details. Invasive carcinoma was found in 4/11(36%) patients and high grade dysplasia in 3/11(27%) patients. We present a case report with noninvasive carcinoma which grew 3mm to 8mm of main pancreatic duct with 16mm cyst at the pancreatic head for one year. Of these, 4 patients had a component of BD-IPMN. Invasive carcinoma was found in only one case with high risk stigmata of jaundice. Our previous study from Jan 2006 to Mar 2013 revealed that invasive carcinoma was found in 6/24(25%) patients and high grade dysplasia in 7/24(29%) patients with MD/Mix-IPMN. While, invasive carcinoma was found in 3/29(10%) patients and high grade dysplasia was found in 5/29(17%) patients with BD-IPMN. Next we investigated 37 patients who were continuously observed. 12 patients of these had a component of MD/Mix-IPMN including 2 cases with high-risk stigmata and 10 cases with worrisome features. The other 25 patients had a component of BD-IPMN including 7 cases with worrisome features. All these observing patients have no aggressive growth of tumor for about two years.
Conclusion:
It was consensus point new guideline made the surgical indication stricter compared to the old one. From now we tend to avoid surgical treatment for IPMN, so another predicting factor of malignancy should be considered through continuous observation.