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Medline ® Abstract for Reference 65

of 'Intraductal papillary mucinous neoplasm of the pancreas (IPMN): Evaluation and management'

Management of pancreatic intraductal papillary mucinous neoplasm in an academic hospital (2005-2010): what follow-up for unoperated patients?
Baiocchi GL, Portolani N, Grazioli L, Mazza G, Gheza F, Bartoli M, Vanzetti E, Giulini SM
Pancreas. 2013 May;42(4):696-700.
OBJECTIVES: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are diagnosed frequently in asymptomatic patients. It is still not clear what follow-up is indicated for patients not undergoing surgical resection.
METHODS: Review of all reports of magnetic resonance cholangiopancreatography (MRCP) from June 2005 to June 2010, identifying all patients diagnosed with IPMN; subsequent reconstruction of the initial therapeutic decision, indications for and adherence to scheduled follow-up, and IPMN evolution by morphology and by biology.
RESULTS: Overall, 4943 MRCP reports were analyzed, identifying 234 patients with IPMN. Although 143 (61.1%) of these were comprised in Sendai criteria for resection, surgical resection was considered in only 42 (17.9%) patients. Of the remainder, 52 were not subjected to any control, 58 to a single short time check, 77 to MRCP-based regular annual follow-up, and 5 were treated for associated ductal adenocarcinoma. With a median follow-up of 39.5 months (range, 12-72), 37.6% of 125 patients in follow-up had a morphological evolution, but only 2.4% has developed a malignant IPMN. No deaths were recorded, directly related to IPMN, in all 187 conservatively managed patients.
CONCLUSIONS: In the analyzed series, fewer patients than expected underwent surgical resection, and only 67.2% undergo regular follow-up, but no more than 2.4% developed malignancy.
From the *Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia; and†1st Department of Radiology, Brescia Civil Hospital, Brescia, Italy.