Mucin-producing tumors of the pancreas: clinicopathological features, surgical treatment, and outcome

Abstract

Mucin-producing tumors (MPTs) of the pancreas are increasingly being recognized. To evaluate the appropriate surgical treatment and predict the prognosis of MPTs, we performed a retrospective clinicopathological study in 51 patients, 27 with benign tumors and 24 with borderline/malignant tumors. Three of the malignant tumors showed stromal invasion and lymph node metastasis on histological examination. Of the 24 patients with borderline/malignant tumors, 2 died of MPTs and 4 died of other diseases. At the last follow-up, 35 patients were alive and well. The 5-year postoperative survival rate was 90% for patients with benign tumors, and 78% of these with borderline/malignant tumors. Five of the patients with borderline/malignant tumors had multicentric tumors. Three of these patients underwent resection of the rest of the pancreas, 5, 6, and 8 years, respectively, after the first operation. Extended radical resection is required for malignant MPT with invasion of the pancreatic stroma. We prefer to perform pancreatogastrostomy or Imanaga's procedure to allow examination of the body and tail of the pancreas by endoscopic retrograde pancreatography after resection of the pancreatic head. Careful follow-up for a long period may be the most prudent approach for detecting multiple MPTs in the residual pancreas after surgical treatment.

Precursors to Pancreatic Cancer

“…It is important to distinguish the colloid from the tubular/ductal types of invasive carcinoma because patients with the former have a better prognosis than patients with the latter (see below) (51). IPMNs may be associated with extrapancreatic malignancies (61)(62)(63). Twelve of 79 patients with an IPMN reported by Kamisawa et al had a synchronous or a metachronous gastric cancer, and 7 had colon cancer (62).…”

Intraductal papillary mucinous tumors of the pancreas

“…The treatment of choice for tumors of the head of the pancreas, the typical location of IPMT [40], is radical pancreatoduodenectomy based on the specifications of an international workshop on surgical procedures in 1998 [37,41,42]. Whether it should be performed as a pylorus-preserving procedure or as the classical KauschWhipple operation is still debated.…”

Risk of additional pancreatic cancer in patients with branch duct intraductal papillary-mucinous neoplasm

“…In their study, K-ras mutations were found in adenomas in 62% of patients with IPMNs, 65% of whom had multiple, distinct mutations in different lesions. These results provide molecular evidence for field cancerization in pancreases bearing IPMNs and suggest that patients with IPMN are at risk for synchronous and/or metachronous multiple tumors before and after surgery [36,55,56].…”

“…An important clinicopathologic feature of IPMN is that multifocal occurrence of IPMN has been observed in the same pancreas [12,16,55,56]. The incidence of tumor multifocality of IPMN ranges from 9.8 to 32% [12,16,55,56], and recurrences after surgical resection have been reported [16,55,56].…”

“…The incidence of tumor multifocality of IPMN ranges from 9.8 to 32% [12,16,55,56], and recurrences after surgical resection have been reported [16,55,56]. A study of IPMNs treated with total pancreatectomy showed multifocal discontinuous sites of dysplasia within the pancreatic ducts [57].…”