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Diameter of Main Pancreatic Duct Is Important for Prediction of Malignancy of IPMN

Satoi, Shumpei; Takeyama, Yoshifumi; Nakai, Takuya; Haji, Seiji; Yasuda, Chikao; Ishikawa, Hajime; Yasuda, Takeo; Shinzaki, Wataru; Kamei, Keiko; Ohyanagi, Harumasa

doi: 10.1097/01.MPA.0000357014.60265.74
Abstracts: Proceedings of the Japan Pancreas Society, 2008, Suizo, the Journal of the Japan Pancreas Society, Volume 23, 2008, Tooru Shimosegawa, MD, Editor-in-Chief: JPS SELECTED ABSTRACT 2
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Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kinki University School of Medicine, Osaka, Japan.

Suizo Vol 23, No 4, pp 481-485.

Intraductal papillary mucinous neoplasm (IPMN) was first described by Ohashi et al. as "mucin-producing cancer" that affected the main pancreatic duct and produced excessive quantities of mucus, which filled and distended the ductal system.1 Prediction of malignancy of IPMN is important not only for indication of operation but for selection of operative procedure. International Consensus Guidelines recommended to resect all main duct and mixed variant IPMNs, and also recommended to resect branch duct IPMNs with symptoms.2 However, the criteria for resection in the branch duct IPMNs is still unclear. This study aimed to determine the predictive factors for malignancy in IPMN, particularly cancer invasion in IPMNs. We reviewed 26 cases with IPMN operated from April 2003 to December 2007. Among them, 21 cases were branched type, and the other were main duct type. We measured diameter of main pancreatic duct, cystic lesion size and intramural nodule size by endoscopic ultrasonography or computed tomography and serum levels of CEA and CA19-9. As for factors to predict malignancy only in branched type, the intramural nodules size and was significantly larger in the cases with cancer than that in the cases without cancer (Table 1). The analysis all types IPMNs showed significant difference in the main duct diameter between 15 benign and 11 malignant cases (5.5 + 4.0 mm vs 10.9 + 4.5 mm, p = 0.005). Moreover, among the 11 cases whose diameter of main pancreatic duct was less than 7 mm, no malignancy was detected. These results suggest that the diameter of main pancreatic duct as well as intramural nodules size is useful for prediction of malignancy and that minimally-invasive surgery such as spleen-preserving distal pancreatectomy can be safely indicated for the cases whose diameter of main pancreatic duct is less than 7 mm.

TABLE 1

TABLE 1

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References:

1. Ohashi K, Murakami Y, Maruyama M. Four cases of mucin-producing cancer of the pancreas on specific findings of the papilla of Vater [in Japanese]. Prog Dig Endoscopy. 1982;20:348-351.
2. Masao Tanaka, Suresh Chari, Volkan Adsay, et al. International Consensus Guidelines for Management of Intraductal Papillary Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas. Pancreatology. 2006;6:17-32.
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