Diagnosis and surgical treatment of intraductal papillary mucinous neoplasm of the biliary tract

Abstract

Objective To study the clinical features of intraductal papillary mucinous neoplasm of the biliary tract (BT-IPMN) and to analyse the diagnostic and surgical patterns. Method The data of 19 patients with BT-IPMN admitted from Jun. 2012 to Jul. 2016 were retrospectively analyzed. Results These 19 (2.3%) patients with BT-IPMN came from 815 patients with biliary tract tumors who were treated in our institution. There were 9 males and 10 females. The male to female ratio was 1.0∶1.1. The mean age was 60.6±12.9 years with a range from 25 to 78 years. Jaundice (in 10 patients) and abdominal discomfort (in 6 patients) were the most common presenting symptoms. Bile duct dilatation and intraluminal mass were typical preoperative imaging findings. All these 19 patients were diagnosed to have BT-IPMN histopathologically. 18 patients underwent surgery in our hospital. Left lateral hepatic sectionectomy or left hepatectomy was performed in 8 patients, pancreaticoduodenectomy in 6, local excision of bile duct and cholangiojejunostomy in 3 and central hepatectomy in 1. The average operating time was 280 minutes and the average amount of intra-operative bleeding was 515 ml. Fourteen patients underwent regional lymph node dissection and 3 positive lymph nodes were detected out of 94 resected lymph nodes. Sixteen patients were followed up from 1 to 51 months with a mean of (25.7±19.5) months. Fourteen of these patients were still surviving. Two patients died 3 and 17 months after operation due to the tumor. Conclusions Intraductal papillary mucinous neoplasm of the biliary tract was very rare. Early diagnosis was not easy. There was a low percentage of lymphatic metastasis. Surgery was the first choice of treatment and complete resection of BT-IPMN was associated with good long-term survival. Key words: Biliary tract; Papillary mucinous neoplasm; Diagnosis; Surgical procedure