PMID- 15082972
OWN - NLM
STAT- MEDLINE
DCOM- 20040521
LR  - 20190514
IS  - 0003-4932 (Print)
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 239
IP  - 5
DP  - 2004 May
TI  - Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical 
      predictors of malignancy and long-term survival following resection.
PG  - 678-85; discussion 685-7
AB  - OBJECTIVE: To describe clinical characteristics and outcomes of a large cohort of 
      intraductal papillary mucinous neoplasms (IPMNs) of the pancreas affecting the 
      main pancreatic duct. SUMMARY BACKGROUND DATA: IPMNs are being diagnosed with 
      increasing frequency. Preoperative determination of malignancy remains 
      problematic, and reported results of long-term survival following resection are 
      conflicting. METHODS: The combined databases from the Massachusetts General 
      Hospital and the Pancreatic Unit of the University of Verona were analyzed. To 
      avoid confusing overlap with mucinous cystic neoplasms, only patients with tumors 
      of the main pancreatic duct (with or without side branch involvement) were 
      included. A total of 140 tumors consecutively resected between 1990 and 2002 were 
      classified as either benign (adenoma and borderline tumors) or malignant 
      (carcinoma in situ or invasive cancer) to compare their characteristics and 
      survival. RESULTS: Men and women were equally affected (mean age 65 years). Seven 
      patients (12%) had adenomas, 40 (28%) borderline tumors, 25 (18%) carcinoma in 
      situ, and 58 (42%) invasive carcinoma. The median age of patients with benign 
      IPMN was 6.4 years younger than those with malignant tumors (P = 0.04). The 
      principal symptoms were abdominal pain (65%), weight loss (44%), acute 
      pancreatitis (23%), jaundice (17%), and onset or worsening of diabetes (12%); 27% 
      of patients were asymptomatic. Jaundice and diabetes were significantly 
      associated with malignant tumors. Five- and 10-year cancer-specific survival for 
      patients with noninvasive tumors was 100%, and comparable survival of the 58 
      patients with invasive carcinoma was 60% and 50%. CONCLUSIONS: Cancer is found in 
      60% of patients with main-duct IPMNs. Patients with malignant tumors are 6 years 
      older than their benign counterparts and have a higher likelihood of presenting 
      with jaundice or new onset diabetes. No patients with benign tumors or carcinoma 
      in situ died of their disease following resection, and those with invasive cancer 
      had a markedly better survival (60% at 5 years) than pancreatic ductal 
      adenocarcinoma. These findings support both the concept of progression of benign 
      IPMNs to invasive cancer and an aggressive policy of resection at diagnosis.
FAU - Salvia, Roberto
AU  - Salvia R
AD  - Department of Surgery, University of Verona, Verona, Italy.
FAU - Fernandez-del Castillo, Carlos
AU  - Fernandez-del Castillo C
FAU - Bassi, Claudio
AU  - Bassi C
FAU - Thayer, Sarah P
AU  - Thayer SP
FAU - Falconi, Massimo
AU  - Falconi M
FAU - Mantovani, William
AU  - Mantovani W
FAU - Pederzoli, Paolo
AU  - Pederzoli P
FAU - Warshaw, Andrew L
AU  - Warshaw AL
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
CIN - Gastroenterology. 2004 Dec;127(6):1853-5. PMID: 15578527
MH  - Aged
MH  - Carcinoma, Pancreatic Ductal/diagnosis/mortality/*surgery
MH  - Carcinoma, Papillary/diagnosis/mortality/*surgery
MH  - Female
MH  - Humans
MH  - Lymphatic Metastasis
MH  - Male
MH  - Middle Aged
MH  - Pancreatic Neoplasms/diagnosis/mortality/*surgery
MH  - Postoperative Complications
PMC - PMC1356276
EDAT- 2004/04/15 05:00
MHDA- 2004/05/22 05:00
PMCR- 2004/11/01
CRDT- 2004/04/15 05:00
PHST- 2004/04/15 05:00 [pubmed]
PHST- 2004/05/22 05:00 [medline]
PHST- 2004/04/15 05:00 [entrez]
PHST- 2004/11/01 00:00 [pmc-release]
AID - 00000658-200405000-00012 [pii]
AID - 0000658-200405000-00012 [pii]
AID - 10.1097/01.sla.0000124386.54496.15 [doi]
PST - ppublish
SO  - Ann Surg. 2004 May;239(5):678-85; discussion 685-7. doi: 
      10.1097/01.sla.0000124386.54496.15.