Observational Study of the Incidence of Pancreatic and Extrapancreatic Malignancies During Surveillance of Patients With Branch-duct Intraductal Papillary Mucinous Neoplasm

Malleo, Giuseppe; Marchegiani, Giovanni; Borin, Alex; Capelli, Paola; Accordini, Federico; Butturini, Giovanni; Pederzoli, Paolo; Bassi, Claudio; Salvia, Roberto

doi:10.1097/sla.0000000000000884

Cited by 71 publications

(56 citation statements)

References 36 publications

(41 reference statements)

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“…Despite the fact that this is the first time that the problematic issue of when to stop surveillance of low-risk lesions was addressed, the poor evidence that is currently available limits its generalizability. Moreover, current literature shows contradictory results regarding this matter, with several studies that analyzed BD-IPMNs reporting the development of malignancy after the initial five year period (28,29,96) whereas other publications showed a trend towards stability once the initial surveillance period has passed (97,98). A recent study involving several institutions analyzed 310 patients with asymptomatic PCLs (99).…”

Section: Current Guidelines and Recommendationsmentioning

confidence: 99%

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Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines.

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Section: Current Guidelines and Recommendationsmentioning

confidence: 99%

“…Initially, the main recommendation was to resect them due to their malignant potential. However, several recent studies have reported significantly lower rates of malignant transformation (ranging from 2-6%) (26)(27)(28)(29), which has leaned the balance towards a more conservative approach.…”

Section: Introductionmentioning

confidence: 99%

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Moris

Wallace

2017

Rev Esp Enferm Dig

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“…Several retrospective series reported distinct pancreatic adenocarcinoma in a different segment of the pancreas away from index IPMN lesion in up to 13 11% of patients during follow-up. [25][26][27][28][29][30][31] We observed 1 patient without WF with cyst size increasing by 50% during surveillance (with benign EUS-FNA cytology) who presented with pancreatic adenocarcinoma in a different part of the pancreas with liver metastasis after 22 months. These results highlight the "fielddefect concept" and the need for continued imaging surveillance in BD-IPMN.…”

Section: 24mentioning

confidence: 99%

Management of branch-duct intraductal papillary mucinous neoplasms: a large single-center study to assess predictors of malignancy and long-term outcomes

Ridtitid

DeWitt

Schmidt

et al. 2016

Gastrointestinal Endoscopy

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“…In a recent series of 90 consecutive resected MCNs of the pancreas, only 4.4% were associated with invasive carcinoma [9] . The risk of progression to cancer is shown to be only 1.4% following 5 years' surveillance of non-resected BD-IPMN [10] .…”

Section: Editorialmentioning

confidence: 99%

“…IPMNs involving only the branch ducts are difficult to handle. The risk for cancer is lower than for main-duct or mixed type IPMN, and according to large studies the incidence of cancer during follow-up seems to be very low [10] . If there are multiple lesions, the diagnosis of IPMN is likely, and the current guidelines for the management of these patients seem to be safe.…”

Section: Editorialmentioning

confidence: 99%

Cystic tumors of the pancreas: Opportunities and risks

Chiaro

Verbeke

2015

WJGP

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neoplasms of the pancreas can be considered as the pancreatic analogon to colonic polyps. Treatment of these precursor lesions at an early stage can potentially reduce pancreas cancer mortality and introduce a new "era" of preemptive pancreatic surgery. However, only few of those lesions have an aggressive behavior. The accuracy of preoperative diagnosis, i.e. , the distinction between the various PCNs is around 60%, and the ability to predict the future outcome is also less accurate. For this reason, a significant number of patients are currently over-treated with an unnecessary, high-risk surgery. Furthermore, the majority of patients with PCN are on life-long follow-up with imaging modality, which has huge cost implications for the Health Care System for limited benefits considering that a significant proportion of PCNs are or behave like benign lesions. The current guidelines for the diagnosis and management of PCNs are more based on expert opinion than on evidence. For all those reasons, the management of cystic tumors of the pancreas remains a controversial area of pancreatology. On one hand, the detection of PCNs and the surgical treatment of pre-cancerous neoplasms can be considered a big opportunity to reduce pancreatic cancer related mortality. On the other hand, PCNs are associated with a considerable risk of under-or over-treatment of patients and incur high costs for the Health Care System. Core tip: The present paper is an editorial focused on the critical problems regarding the management strategy of pancreatic cystic neoplasms (PCNs). Being a pre-cancerous condition in most of the cases, PCNs represent a unique opportunity to prevent pancreatic cancer and to develop preemptive pancreatic surgery programs. However, the lack of predictive factors of the behaviour of these lesions, the low accuracy of AbstractPancreatic cystic neoplasms (PCNs) are a high prevalence disease. It is estimated that about 20% of the general population is affected by PCNs. Some of those lesions can progress till cancer, while others behave in a benign fashion. In particular intraductal papillary mucinous 29May 15, 2015|Volume 6|Issue 2|

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Observational Study of the Incidence of Pancreatic and Extrapancreatic Malignancies During Surveillance of Patients With Branch-duct Intraductal Papillary Mucinous Neoplasm

Cited by 71 publications

References 36 publications

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

Management of branch-duct intraductal papillary mucinous neoplasms: a large single-center study to assess predictors of malignancy and long-term outcomes

Cystic tumors of the pancreas: Opportunities and risks

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