PMID- 25759534 OWN - NLM STAT- MEDLINE DCOM- 20150928 LR - 20181113 IS - 2219-2840 (Electronic) IS - 1007-9327 (Print) IS - 1007-9327 (Linking) VI - 21 IP - 9 DP - 2015 Mar 7 TI - Outcomes of nonresected main-duct intraductal papillary mucinous neoplasms of the pancreas. PG - 2658-67 LID - 10.3748/wjg.v21.i9.2658 [doi] AB - 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. FAU - Daude, Mathieu AU - Daude M AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Muscari, Fabrice AU - Muscari F AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Buscail, Camille AU - Buscail C AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Carrere, Nicolas AU - Carrere N AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Otal, Philippe AU - Otal P AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Selves, Janick AU - Selves J AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Buscail, Louis AU - Buscail L AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. FAU - Bournet, Barbara AU - Bournet B AD - Mathieu Daude, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France. LA - eng PT - Comparative Study PT - Journal Article PL - United States TA - World J Gastroenterol JT - World journal of gastroenterology JID - 100883448 SB - IM MH - Adenocarcinoma, Mucinous/mortality/pathology/surgery/*therapy MH - Adenocarcinoma, Papillary/mortality/pathology/surgery/*therapy MH - Adult MH - Aged MH - Aged, 80 and over MH - Cholangiopancreatography, Endoscopic Retrograde MH - Cholangiopancreatography, Magnetic Resonance MH - Disease Progression MH - Endoscopic Ultrasound-Guided Fine Needle Aspiration MH - Endosonography MH - Female MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Neoplasm Recurrence, Local MH - *Pancreatectomy/adverse effects/mortality MH - Pancreatic Neoplasms/mortality/pathology/surgery/*therapy MH - Predictive Value of Tests MH - Proportional Hazards Models MH - Retrospective Studies MH - Risk Factors MH - Time Factors MH - Tomography, X-Ray Computed MH - Treatment Outcome PMC - PMC4351216 OTO - NOTNLM OT - Main-duct intraductal papillary mucinous neoplasms OT - Natural history OT - Pancreatic surgery OT - Prognosis OT - Risk of malignancy EDAT- 2015/03/12 06:00 MHDA- 2015/09/29 06:00 PMCR- 2015/03/07 CRDT- 2015/03/12 06:00 PHST- 2014/09/04 00:00 [received] PHST- 2014/10/12 00:00 [revised] PHST- 2014/12/05 00:00 [accepted] PHST- 2015/03/12 06:00 [entrez] PHST- 2015/03/12 06:00 [pubmed] PHST- 2015/09/29 06:00 [medline] PHST- 2015/03/07 00:00 [pmc-release] AID - 10.3748/wjg.v21.i9.2658 [doi] PST - ppublish SO - World J Gastroenterol. 2015 Mar 7;21(9):2658-67. doi: 10.3748/wjg.v21.i9.2658.