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Follow up of Branch Duct Intraductal Papillary Mucinous Neoplasms (BD-IPMN) of the pancreas with a cyst over 30mm in diameter: A single center experience
Abstracts / Pancreatology 14 (2014) S1eS129
Aims: The aim of our study was to examine independent factors (gender, presence of chronic pancreatitis, anatomic localization, mucin expression) as potential risk factors for malignant IPMTs. Patients & methods: 48 patients underwent surgical resection were proved to have IPMT between the period of 2002-2013. Samples were grouped according to type of the tumour as main duct-(MD), branch duct(BD) or mixed-type (MX) IPMTs. We created subgroups based on the malignant behaviour and the mucin expression profile, like intestinal (I), pancreatobiliary (PB) and gastric-type (G) IPMTs. We examined the presence of chronic pancreatitis and the correlation with the presence of malignant IPMTs. Results: 12 BD-, 15 MD- and 21 MX- type IPMTs were found. 16,7% of the patients had low-grade- and 33,3% had high-grade dysplasia. Based on the mucin expression profile 14,2% of the G-, 37,5% of the I- and 75% of the PBtype IPMTs were found to be malignant. 79,2% of the malignant IPMTs, were localized in the head of the pancreas. 33,3% of the patients without chronic pancreatitis, while 66,7% of the patients with chronic pancreatitis had malignant IPMT. Conclusion: The presence of chronic pancreatitis may have an important role to increase the malignant behaviour of the IPMTs. Lack of MUC1 expression may be related to less invasive characteristics of IPMTs. MUC2+ alone, or MUC1+ and MUC5AC+ expression together can predict the malignant potential of IPMTs.
W-028. Clinical significance of extrapancreatic primary cancers in patients with IPMN.- An analysis of experiences in a single Japanese centerAkina Kuwahara a, Hiroshi Noda a, Fumiaki Watanabe a, Takaharu Kato a, Kosuke Ichida a, Toshiki Rikiyama b a
Department of Surgery, Saitama Medical Center, Jichi Medical University, Japan b Jichi Medical University Saitama Medical Center, Gastroenterological surgery, Japan Background: It has been reported intraductal papillary mucinous neoplasm (IPMN) patients were frequently associated with extrapancreatic cancer(EPC). Therefore, there is a possibility that EPC determines the patients' prognosis, though the etiology of EPC in IPMN patients has not been well studied. Aims: We searched the frequencies, site of organs of EPC and its influence to the prognosis of patients with IPMN. Patients & methods: Sixty patients who underwent surgery for IPMN, which was histopatologycally confirmed, in our department from1991 through Augast 2013 were enrolled in this study. We examined the clinicopathological characteristics of EPC and IPMN, and the correlation between them. Results: In 60 patients with IPMN, 15 cases (25%) had an history of EPC. In 15 IPMN patients with EPC, 5 cases had gastric cancer, 4 cases had colon cancer. Among 15 cases, synchronous EPCs were 4 patients and metachronous EPCs were in 11 patients. Five of 11 cases, they were diagnosed after IPMN operation during the postoperative surveillance. The median time between IPMN operation and the diagnosis of metachronous EPC of 5 cases was 27 months, and 3 patients were diagnosed by a surveillance for follow-up of IPMN and underwent curative treatment. We investigated the risk factors of the occurence of EPC in the clinicopathological characteristics of IPMN, such as the patients' age when diagnosed with IPMN, pathological type (adenoma or adenocarcinoma) , subtype of IPMN (main pancreatic duct type or branchduct type), the size of the cyst, the size of main pancreatic duct, and the preoperative values of CEA andCA19-9. But there was no significant correlation between them. Conclusion: Early detection and treatment of EPC during IPMN postoperatice surveillance may lead to a better prognosis of the patients. We should conduct a close systemic surveillance for the postoperative followup of IPMN patients for an early detection of EPC.
S29
W-029. Follow up of Branch Duct Intraductal Papillary Mucinous Neoplasms (BD-IPMN) of the pancreas with a cyst over 30mm in diameter: A single center experience Atsushi Kubo, Etsuji Ishida, Tsukasa Yoshida, Yoshie Kiyosuke, Kazuhiro Matsueda, Hiroshi Yamamoto Kurashiki Central Hospital, Gastroenterology, Japan Background: In the IPMN/MCN international consensus guidelines, BDIPMN without suspicious malignant fingings have changed from rather early resectionto more deliberateobservationwhen a cystisover30mm indiameter. Aims: This study was to clarify the natural history of BD-IPMN with a cyst > 30mm. Patients & methods: 719 patients with BD-IPMNs were treated in our institute from 1996 to 2013. 99 patients with BD-IPMNs with a cyst > 30mm and more than 1 year imaging follow-up were identified and their cases reviewed retrospectively. Evaluation points were 1) initial clinical data, 2) progresson rate, and 3) outcomes. Results: Of 99 patients, median observation preiod was 54.8 months (12.2-214.8 months) (mean age 72y, male 63%). The initial median size of the cystic lesion was 33mm (30-65), the initial median diameter of the MPD was 3mm (2-15). 4 patients had mural nodules. 2) 51 patients exhibited progression with an increasing cyst size, MPD diameter, or appearance and/ or enlagement of mural nodules. Surgical resection was performed in 7 with progression. Pathological diagnosis was 1 invasive IPMC, 2 carcinomas in site, and 4 adenomas. 3) 17 patients were died. Of 17 patients, 2 died of inavasive IPMC, 3 newly developed ordinaly pancreatic cancer, 8 cancer of other organs, and 4 other benign disease. Conclusion: The progressin rate of is extremely high during this periods, but few 5 patients died of IPMC and pancreatic cancer. This suggests that observation may be reasonable approach to BD-IPMN with a cyst > 30mm with careful imaging follow-up toward incidence of IPMC and pancreatic cancer.
W-030. Prognosis of pancreatic cystic neoplasms in elderly patients: Could be followed up without resection? Jae Seon Kim a, Hyo Jung Kim b, Beom Jae Lee b, Jong-Jae Park b, Hong Sik Lee c, Chang Duck Kim c, Young-Tae Bak b a
Korea University Guro Hospital,Internal Medicine, South Korea Korea University Guro Hospital, Internal Medicine, South Korea c Korea University Anam Hospital, Internal Medicine, South Korea b
Background: As opposed to ductal adenocarcinoma, pancreatic cystic neoplasm (PCN) is slow-growing, and favorable prognosis has been reported even in the setting of malignant degeneration. Aims: The aim of this study was to elucidate the clinical outcome of PCN in elderly patients. Patients & methods: Patients followed for longer than 1 year were analyzed retrospectively. Results: Total 201 patients were included (104 patients, < 65 years, older group and 97 patients, < 65 years, younger group). Surgical resection was done in 68 cases and malignancy was confirmed in only 4% (3/68). Postoperative morbidity developed in 22.2% (6/27) of the older group and 21.9% (9/41) of the younger group. The 133 patients (77 patients of the older group and 56 patients were the younger group) were fallowed without surgery (mean fallow-up duration ¼ 41 months), Patients with the risk for malignancy were 13 cases in each group. In older group, 9 cases were fallowed due to perioperative morbidity, and 4 cases refused surgery. In younger group, all refused surgery. During fallow-up, the diameter of PCN was increased in 16.9% (13/77) of the older group and 12.5% (7/56) of the younger group. Among them, 4 cases of the older group and 1 case of the younger group were proved to have no cancer after operation. In other fallowed patients, neither new cancerous changes nor any PCN-related mortality developed. Conclusion: In elderly patients with PCN, follow-up observation without surgery seems to be a rather safe option.
Aims: The aim of our study was to examine independent factors (gender, presence of chronic pancreatitis, anatomic localization, mucin expression) as potential risk factors for malignant IPMTs. Patients & methods: 48 patients underwent surgical resection were proved to have IPMT between the period of 2002-2013. Samples were grouped according to type of the tumour as main duct-(MD), branch duct(BD) or mixed-type (MX) IPMTs. We created subgroups based on the malignant behaviour and the mucin expression profile, like intestinal (I), pancreatobiliary (PB) and gastric-type (G) IPMTs. We examined the presence of chronic pancreatitis and the correlation with the presence of malignant IPMTs. Results: 12 BD-, 15 MD- and 21 MX- type IPMTs were found. 16,7% of the patients had low-grade- and 33,3% had high-grade dysplasia. Based on the mucin expression profile 14,2% of the G-, 37,5% of the I- and 75% of the PBtype IPMTs were found to be malignant. 79,2% of the malignant IPMTs, were localized in the head of the pancreas. 33,3% of the patients without chronic pancreatitis, while 66,7% of the patients with chronic pancreatitis had malignant IPMT. Conclusion: The presence of chronic pancreatitis may have an important role to increase the malignant behaviour of the IPMTs. Lack of MUC1 expression may be related to less invasive characteristics of IPMTs. MUC2+ alone, or MUC1+ and MUC5AC+ expression together can predict the malignant potential of IPMTs.
W-028. Clinical significance of extrapancreatic primary cancers in patients with IPMN.- An analysis of experiences in a single Japanese centerAkina Kuwahara a, Hiroshi Noda a, Fumiaki Watanabe a, Takaharu Kato a, Kosuke Ichida a, Toshiki Rikiyama b a
Department of Surgery, Saitama Medical Center, Jichi Medical University, Japan b Jichi Medical University Saitama Medical Center, Gastroenterological surgery, Japan Background: It has been reported intraductal papillary mucinous neoplasm (IPMN) patients were frequently associated with extrapancreatic cancer(EPC). Therefore, there is a possibility that EPC determines the patients' prognosis, though the etiology of EPC in IPMN patients has not been well studied. Aims: We searched the frequencies, site of organs of EPC and its influence to the prognosis of patients with IPMN. Patients & methods: Sixty patients who underwent surgery for IPMN, which was histopatologycally confirmed, in our department from1991 through Augast 2013 were enrolled in this study. We examined the clinicopathological characteristics of EPC and IPMN, and the correlation between them. Results: In 60 patients with IPMN, 15 cases (25%) had an history of EPC. In 15 IPMN patients with EPC, 5 cases had gastric cancer, 4 cases had colon cancer. Among 15 cases, synchronous EPCs were 4 patients and metachronous EPCs were in 11 patients. Five of 11 cases, they were diagnosed after IPMN operation during the postoperative surveillance. The median time between IPMN operation and the diagnosis of metachronous EPC of 5 cases was 27 months, and 3 patients were diagnosed by a surveillance for follow-up of IPMN and underwent curative treatment. We investigated the risk factors of the occurence of EPC in the clinicopathological characteristics of IPMN, such as the patients' age when diagnosed with IPMN, pathological type (adenoma or adenocarcinoma) , subtype of IPMN (main pancreatic duct type or branchduct type), the size of the cyst, the size of main pancreatic duct, and the preoperative values of CEA andCA19-9. But there was no significant correlation between them. Conclusion: Early detection and treatment of EPC during IPMN postoperatice surveillance may lead to a better prognosis of the patients. We should conduct a close systemic surveillance for the postoperative followup of IPMN patients for an early detection of EPC.
S29
W-029. Follow up of Branch Duct Intraductal Papillary Mucinous Neoplasms (BD-IPMN) of the pancreas with a cyst over 30mm in diameter: A single center experience Atsushi Kubo, Etsuji Ishida, Tsukasa Yoshida, Yoshie Kiyosuke, Kazuhiro Matsueda, Hiroshi Yamamoto Kurashiki Central Hospital, Gastroenterology, Japan Background: In the IPMN/MCN international consensus guidelines, BDIPMN without suspicious malignant fingings have changed from rather early resectionto more deliberateobservationwhen a cystisover30mm indiameter. Aims: This study was to clarify the natural history of BD-IPMN with a cyst > 30mm. Patients & methods: 719 patients with BD-IPMNs were treated in our institute from 1996 to 2013. 99 patients with BD-IPMNs with a cyst > 30mm and more than 1 year imaging follow-up were identified and their cases reviewed retrospectively. Evaluation points were 1) initial clinical data, 2) progresson rate, and 3) outcomes. Results: Of 99 patients, median observation preiod was 54.8 months (12.2-214.8 months) (mean age 72y, male 63%). The initial median size of the cystic lesion was 33mm (30-65), the initial median diameter of the MPD was 3mm (2-15). 4 patients had mural nodules. 2) 51 patients exhibited progression with an increasing cyst size, MPD diameter, or appearance and/ or enlagement of mural nodules. Surgical resection was performed in 7 with progression. Pathological diagnosis was 1 invasive IPMC, 2 carcinomas in site, and 4 adenomas. 3) 17 patients were died. Of 17 patients, 2 died of inavasive IPMC, 3 newly developed ordinaly pancreatic cancer, 8 cancer of other organs, and 4 other benign disease. Conclusion: The progressin rate of is extremely high during this periods, but few 5 patients died of IPMC and pancreatic cancer. This suggests that observation may be reasonable approach to BD-IPMN with a cyst > 30mm with careful imaging follow-up toward incidence of IPMC and pancreatic cancer.
W-030. Prognosis of pancreatic cystic neoplasms in elderly patients: Could be followed up without resection? Jae Seon Kim a, Hyo Jung Kim b, Beom Jae Lee b, Jong-Jae Park b, Hong Sik Lee c, Chang Duck Kim c, Young-Tae Bak b a
Korea University Guro Hospital,Internal Medicine, South Korea Korea University Guro Hospital, Internal Medicine, South Korea c Korea University Anam Hospital, Internal Medicine, South Korea b
Background: As opposed to ductal adenocarcinoma, pancreatic cystic neoplasm (PCN) is slow-growing, and favorable prognosis has been reported even in the setting of malignant degeneration. Aims: The aim of this study was to elucidate the clinical outcome of PCN in elderly patients. Patients & methods: Patients followed for longer than 1 year were analyzed retrospectively. Results: Total 201 patients were included (104 patients, < 65 years, older group and 97 patients, < 65 years, younger group). Surgical resection was done in 68 cases and malignancy was confirmed in only 4% (3/68). Postoperative morbidity developed in 22.2% (6/27) of the older group and 21.9% (9/41) of the younger group. The 133 patients (77 patients of the older group and 56 patients were the younger group) were fallowed without surgery (mean fallow-up duration ¼ 41 months), Patients with the risk for malignancy were 13 cases in each group. In older group, 9 cases were fallowed due to perioperative morbidity, and 4 cases refused surgery. In younger group, all refused surgery. During fallow-up, the diameter of PCN was increased in 16.9% (13/77) of the older group and 12.5% (7/56) of the younger group. Among them, 4 cases of the older group and 1 case of the younger group were proved to have no cancer after operation. In other fallowed patients, neither new cancerous changes nor any PCN-related mortality developed. Conclusion: In elderly patients with PCN, follow-up observation without surgery seems to be a rather safe option.