For patients with suspected IPMNs, we present an independently validated model for the prediction of high-risk disease.

No abstract

This multi-institutional study validated 2 CF protein marker models for preoperative identification of high-risk IPMN. When combined with a clinical nomogram, the ability to predict high-grade dysplasia was even stronger.

About a third of patients with pancreatic cancer present with locally advanced disease that is not amenable to resection. Because these patients have localized disease, conventional ablative therapies (thermal ablation and cryoablation) have the potential to be beneficial, but their use is inherently limited in the pancreas. These limitations could be overcome by irreversible electroporation-a novel, non-thermal ablative method that is gaining popularity for the treatment of many soft tissue tumors, including those of the pancreas. This review summarizes the status of this technique in the treatment of locally advanced pancreatic cancer. Most of the evidence on efficacy and safety is based on non-randomized prospective series, which show that irreversible electroporation may improve overall survival and pain control in locally advanced pancreatic cancer. As experience with this procedure increases, randomized controlled trials are needed to document its efficacy in locally advanced pancreatic cancer more precisely.

In this study, 22% of patients had disease progression following resection of noninvasive or microinvasive IPMN; 16% of these progressions represented invasive disease. These patients represent a high-risk group and should undergo long-term radiographic surveillance.

Background: Post-operative peripancreatic fluid collection (PFC) is a common complication following pancreatic resection which can be managed with endoscopic or percutaneous drainage.Methods: Patients who underwent either endoscopic or percutaneous drainage of post-operative PFC were extracted from a prospectively-maintained database. The two groups were matched for surgery type, presence of a surgical drain and timing of drainage.Results: Thirty-nine matched patients were identified in each group with a median age of 62 years. For primary drainage, technical success was achieved in almost all patients in both endoscopic and percutaneous groups (100% and 97%, p = NS); clinical success was achieved in 67% and 59%, respectively (p = 0.63). At least one "salvage" drainage procedure was required in 13 endoscopic patients versus 16 in the percutaneous group. Clinical success was achieved following the first salvage.Procedure in 85% of the endoscopic patients and 88% of the percutaneous patients (p = 0.62). Stent/ drain duration (59 vs 33 days, p < 0.001) and number of post-procedural CT studies (2 vs 1, p = 0.02) were significantly higher in the endoscopic group. There was no difference in length of stay, complication, or recurrence between the two groups. Conclusion:Endoscopic drainage of post-operative PFC appears to be safe and effective with comparable success rates and outcomes to percutaneous drainage.

Given the widespread use of high quality cross-sectional imaging, cystic lesions of the pancreas are being diagnosed more frequently. Management of these lesions is challenging as it largely depends on radiologic and cyst fluid markers to discriminate between benign and pre-cancerous lesions, however the accuracy of these tests is limited, and unable to predict malignancy with certainty. While asymptomatic serous cystadenomas (SCA) can be managed conservatively, mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) are more difficult to manage given their variable potential for malignancy. A selective approach, based on the preoperative likelihood of high-grade dysplasia or invasive disease, is now the standard of care. Current research is focusing on the development of pre-operative markers for discriminating between histopathologic sub-types, and for identifying the degree of dysplasia in patients with precancerous mucinous lesions. Improvements in these diagnostic tools will hopefully limit resection to patients with high-risk lesions, and spare patients with low-risk or benign lesions the risks of pancreatectomy.

Resection for IPMN is infrequent in young patients, but when they are resected, IPMNs from young patients demonstrate different epithelial subtypes from those in older patients and more favorable prognosis.