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Medline ® Abstract for Reference 59

of 'Intraductal papillary mucinous neoplasm of the pancreas (IPMN): Pathophysiology and clinical manifestations'

Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts.
Salvia R, Partelli S, Crippa S, Landoni L, Capelli P, Manfredi R, Bassi C, Pederzoli P
Am J Surg. 2009;198(5):709.
INTRODUCTION: The appropriate management of patients with branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with multiple involvements of branch ducts (multifocal BD-IPMN) remains challenging.
PATIENTS AND METHODS: Our database of patients affected by IPMN was queried to identify patients with a clinicoradiologic or a pathologic diagnosis of multifocal BD-IPMN between January 1990 and December 2006.
RESULTS: One hundred thirty-one patients (52 male and 79 female; median age 67 years) had a clinicoradiologic or a histopathologic diagnosis of multifocal BD-IPMN. Ten patients (7.6%) underwent surgery. After a median follow-up of 40 months (range 12 to 127) all the 121 patients conservatively managed are alive, and none underwent surgery during follow-up. One patient with invasive carcinoma developed hepatic metastases and died of disease 88 months after surgery.
COMMENTS: Patients with branch-side IPMN can be conservatively managed, but when multifocality is present follow-up may be problematic because of the number of lesions to be evaluated. The nonoperative management of well-selected patients with BD-IPMN, even in the multifocal setting, seems to be safe and reliable.
Department of Surgery, University of Verona, Verona, Italy. roberto.salvia@medicina.univr.it