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A Retrospective Analysis of Resectability of Malignant Intraductal Papillary Mucinious Neoplasms


Rafiq, Ehsan MD1; Ahmad, Usman MD2; Bawany, Muhammad MD1; De Las Casas, Luis MD3; Nawras, Ali MD, FACG2

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American Journal of Gastroenterology: October 2013 - Volume 108 - Issue - p S66
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Purpose: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized pancreatic tumor with clear malignant potential and progression to invasive adenocarcinoma. Concomitant foci of adenocarcinoma are found in about 40% of the newly diagnosed IPMNs. There is no definite data about the resectability of IPMNs with concomitant foci of adenocarcinoma diagnosed by endoscopic ultrasound (EUS)-guided fine-needle aspiration cytology (FNAC).

Methods: We conducted a single-center retrospective study to assess the resectability of IPMNs with foci of adenocarcinoma diagnosed by EUS-guided FNAC between March 2010 and March 2013.

Results: A total of 288 FNAC were performed for cystic pancreatic lesions, among which 68 were diagnosed as IPMN. Mean age of IPMN patients was 71.1 years (range 52-87 years). Gender distribution was 32 males and 36 females. Eight (11.7%) patients with IPMN (three males, five females) had concomitant foci of adenocarcinoma on FNAC. Four patients (three males, one female) had resectable disease while in the other four (all females) IPMNs were non-resectable due to distant metastasis (three patients) and locally advanced disease (one patient). Patients with nonresectable disease were older (mean age 76 years) compared to those with resectable disease (mean age 66 years).

Conclusion: Resectability of IPMNs with concomitant foci of adenocarcinoma in our study is 50%, which is significantly more than the resectability of pancreatic adenocarcinoma in general (15-20%). Our findings show that patients with IPMN and an associated non-resectable invasive carcinoma are on average 10 years older than those with resectable malignant IPMNs, suggesting that it takes years for a malignant IPMN to become advanced and non-resectable.

Table. Demographic characteristics of IPMN patient population
© The American College of Gastroenterology 2013. All Rights Reserved.