Sendai criteria is safe for follow up of patients with branch duct IPMN

Abstract

Introduction: Branch duct intraductal papillary mucinous neoplasm (BD-IPMN) of the pancreas can exhibit various degrees of dysplasia, and pancreatic cancer may develop in up to 20%. The Sendai Criteria recommend that patients with ‘high-risk stigmata' (jaundice, enhanced solid component, and main pancreatic duct size ≥10 mm) should undergo resection. Patients with ‘worrisome features' (cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, main pancreatic duct size 5–9 mm, abrupt change in main pancreatic duct caliber with distal pancreatic atrophy, lymphadenopathy, and clinical acute pancreatitis) should be evaluated by endoscopic ultrasonography. The objective of this study is to analyze our population of patients with BD-IPMN. Methods: We perform a retrospective analysis of a prospective database including population of with type II IPMNs. Patients were selected for follow up according to 2006 Sendai criteria. All the patients completed the follow up at our institution exclusively. Results: 118 BD-IPMN were diagnosed. Mean age of 66 (31–91). Most were incidentally diagnosed. Only 10% required surgery. The reason to indicate surgery were: pain (8), the presence of mural nodules (1) and increase in size (3). No patient presented invasive cancer on pathology examination. Coexistence of oncological disease was found in 15% of these patients. Conclusion: The management of small BD-IPMNs remains controversial. The 2012 guidelines should be considered to indicate surgery and patients who do not undergo resection should undergo careful surveillance. Sendai criteria is a safe strategy for follow up of patients with type II IPMN.