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Segmental Versus Diffuse Main Duct Intraductal Papillary Mucinous Neoplasm: Examination of Main Pancreatic Duct Morphology and Implications for Malignancy Risk and Extent of Surgical Resection.
Ecker, Brett L; Dickinson, Shannan M; Saadat, Lily V; Tao, Alice J; Pulvirenti, Alessandra; Balachandran, Vinod P; D'Angelica, Michael I; Drebin, Jeffrey A; Kingham, T P; Jarnagin, William R; Wei, Alice C; Gonen, Mithat; Soares, Kevin C.
Afiliação
  • Ecker BL; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Dickinson SM; Division of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
  • Saadat LV; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Tao AJ; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Pulvirenti A; Weill Cornell Medical College, New York, NY.
  • Balachandran VP; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • D'Angelica MI; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Drebin JA; Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Kingham TP; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Jarnagin WR; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Wei AC; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Gonen M; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Soares KC; Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Surg ; 278(1): 110-117, 2023 Jul 01.
Article em En | MEDLINE | ID: mdl-35950775
ABSTRACT

OBJECTIVE:

To determine whether the morphologic features of the main pancreatic duct (MPD) of main-duct-involved-intraductal papillary mucinous neoplasm (IPMN) (ie, main duct or mixed main duct/side branch) have implications for the risk of malignancy and extent of resection.

BACKGROUND:

International consensus guidelines acknowledge the presence of various MPD morphologies (ie, diffuse vs segmental main-duct-involved-IPMN) without a precise definition of each entity and with limited data to guide treatment strategy.

METHODS:

All consecutive main-duct-involved-IPMN patients (2005-2019) with a MPD diameter ≥5 mm by cross-sectional imaging were reviewed from a prospective institutional database. Morphologic features of the MPD were correlated with the identification of high-grade dysplasia or pancreatic ductal adenocarcinoma (HGD/PDAC) by logistic regression modeling. In patients who underwent partial pancreatectomy, preoperative MPD morphologic features were correlated with the future development of HGD/PDAC in the pancreatic remnant by Cox hazards modeling.

RESULTS:

In a cohort of 214 main-duct-involved-IPMN patients, the overall rate of HGD/PDAC was 54.2%. MPD morphologic characteristics associated with HGD/PDAC included maximal MPD diameter (5-10 mm 29.8%; 10-14 mm 59.0%; 15-19 mm 78.6%; ≥20 mm 95.8%; P <0.001), segmental extent of maximal dilation (<25% 28.2%; 25%-49% 54.9%; 50%-74% 63.1%; ≥75% 67.9%; P =0.002), and nonsegmental MPD diameter (<5 mm 21.5% vs ≥5 mm 78.5%, P <0.001). Diffuse MPD dilation involving ≥90% extent was rare (5.6%). After a median follow-up of 50 months, 7 (7.2%) patients who underwent partial pancreatectomy for IPMN without associated PDAC developed HGD/PDAC in the pancreatic remnant. Maximal MPD diameter, segmental extent of maximal dilation, or nonsegmental MPD diameter were not associated with the development of HGD/PDAC in the pancreatic remnant. However, a mural nodule on preoperative imaging was associated with the development of HGD/PDAC in the pancreatic remnant.

CONCLUSIONS:

"Diffuse" involvement with homogenous dilation of the MPD was rare. For the majority of patients with segmental main-duct-involved-IPMN, the MPD morphology conferred malignancy risk. Duct morphology was not predictive for the development of HGD or invasive disease in the pancreatic remnant, implying the safety of limited pancreatic resection for initial surgical management.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Carcinoma Ductal Pancreático / Neoplasias Intraductais Pancreáticas Tipo de estudo: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Carcinoma Ductal Pancreático / Neoplasias Intraductais Pancreáticas Tipo de estudo: Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Ann Surg Ano de publicação: 2023 Tipo de documento: Article