Multicenter experience of intraductal papillary mucinous neoplasms (IPMN)

Abstract

Background: Pancreatic cystic neoplasms include serous tumors, pseudopapillary neoplasms mucinous tumors, and IPMN. Sendai criteria, last update Fukuoka criteria, have increased attention on IPMN. Methods: We retrospectively reviewed patients with IPMN at Getafe Hospital, Guadalajara Hospital and Miguel Servet Hospital, Spain, between 2009-2016. Results: Data were collected from 26 patients: 61.54% males, 38.46% females. Median age: 66. 26.92% were asymptomatic. Most frequent symptoms: pancreatitis 19.23%, obstructive jaundice 15.38% Radiological findings: MD-IPMN 50%, BD-IPMN 34.62%, mixed-type 7.69%, and without characterization 7.69%. Mean size: 37.6±17.2mm. Most frequent localization: head in 15 patients. Surgical indication: based on symptoms in 57.69%, suspected malignancy in 30.77%, MD-IPMN≥10mm in 1 patient and asymptomatic BD-IPMN≥30mm in 2 Surgical tecnique: Wipple procedure 38.46%; distal pancreatectomy 34.62%, total duodenopancreatectomy 23.08% and central pancreatectomy 3.85%. Histological study: invasive IPMN 40'74%, high-grade displasia/carcinoma in situ in 5 cases, moderate dysplasia in 3, low-grade in 4 and no dysplasia in 3 patients. Conclusion: IPMN preoperative diagnosis should determine their existence, anatomical type and risk of malignancy. Surgical indications, by Fukuoka criteria, include symptoms, MD-IPMN≥10mm and risk of malignancy (61.6% risk in MD-IPMN and 25.5% in BD-IPMN). This relative low frequency would justify conservative treatment in many of them.