Surveillance of patients with intraductal papillary mucinous neoplasm with and without pancreatectomy with special reference to the incidence of concomitant pancreatic ductal adenocarcinoma

Date, Kenjiro; Ohtsuka, Takao; Nakamura, So; Mochidome, Naoki; Mori, Yasuhisa; Miyasaka, Yoshihiro; Oda, Yoshinao; Nakamura, Masafumi

doi:10.1016/j.surg.2017.09.040

Cited by 25 publications

(18 citation statements)

References 29 publications

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“…It is now widely accepted that patients with IPMN who undergo partial pancreatectomy reportedly remain at risk of developing metachronous IPMN or concomitant PDAC 571112. Moreover, some patients have secondary IPMNs with HGD/IC, which is an indication for resection, although the initial surgical margins were free from neoplastic lesions 1113.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are little good long-term data to indicate whether surveillance can be safely discontinued after long-term stability 2. On the contrary, most of studies suggested that long-term surveillance in patients with IPMN should be necessary and important because of the potential for secondary or recurrent development of HRL, such as concomitant PDAC 245711. These metachronous lesions often develop more than 5–10 years after initial operation and the cumulative 5-year incidence of the development of concomitant HRL ranges from 2.2 to 8.8% 45671112192021.…”

Section: Discussionmentioning

confidence: 99%

“…Also, it is recognized that a proportion of resected patients for IPMN evolve over time and can become metachronous IPMN that patients are at an increased risk of developing conventional pancreatic ductal adenocarcinoma (PDAC) elsewhere in the residual gland. Because of this, all patients with IPMN, including even those with non-invasive IPMN with negative surgical margin, should undergo surveillance after resection to detect the development of a new IPMN requiring surgery or concomitant PDAC 4567. However, the risk factors and characteristics of metachronous occurrence of IPMNs in the remnant pancreas have been unclear.…”

Section: Introductionmentioning

confidence: 99%

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Subtype of intraductal papillary mucinous neoplasm of the pancreas is important to the development of metachronous high-risk lesions after pancreatectomy

Kwon

Ryu

Kim

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsAlthough intraductal papillary mucinous neoplasm (IPMN) has showed a favorable prognosis compared to pancreatic ductal adenocarcinoma, its recurrence patterns have somewhat questionable in detail. After partial pancreatectomy for IPMN, the evaluation for risk of metachronous occurrence of high-risk lesions (HRL) in the residual pancreas is important to establish a postoperative surveillance modality and duration of follow-up. This study aimed to evaluate the factors that may predict the metachronous occurrence of HRL in the remnant pancreas after surgery of the IPMN.MethodsFrom 2005 to 2016, clinicopathologic and surveillance data for 346 consecutive patients who underwent surgical resection for IPMN were reviewed retrospectively. Histologic subtype was classified as gastric, intestinal, pancreato-biliary, or oncocytic type.ResultsAll of IPMN were classified as main duct (n=64, 18.5%), branch duct (n=171, 49.4%), and mixed type (n=111, 32.1%). Forty-eight patients (13.9%) experienced recurrence during follow-up. Among these, 9 patients (2.6%) were identified to metachronous development of HRL in the remnant pancreas. After multivariate analysis, high-grade dysplasia (HGD) or invasive carcinoma (IC) compared to low- or intermediate dysplasia was only independent risk factor for recurrence (HR 3.688, 95% CI 2.124– 12.524, p=0.009). The independent risk factors for metachronous development were HGD/IC (HR 8.414, 95% CI 4.310– 16.426, p=0.001), and intestinal/pancreato-biliary subtype compared to gastric subtype (HR 7.874, 95% CI 3.650– 27.027, p=0.010).ConclusionsPatients with high-grade dysplasia or invasive carcinoma, and with intestinal or pancreatobiliary subtype should undergo close, long-term surveillance of the remnant pancreas after initial resection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subtype of intraductal papillary mucinous neoplasm of the pancreas is important to the development of metachronous high-risk lesions after pancreatectomy

Kwon

Ryu

Kim

et al. 2019

Ann Hepatobiliary Pancreat Surg

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“…These diseases are predictive factors for the early detection of HLRs, 10,11 and many early stage HLRs described in the literature were found during the assessment or surveillance of these comorbid diseases. 10,11 In addition, Date et al 25 demonstrated recently that patients who underwent partial pancreatectomy for HRL concomitant with IPMN had a high risk of developing a second concomitant HLR in the remnant pancreas. Detailed molecular and genetic assessments of HLR might lead to further understanding of the mechanisms of development of PanIN and PDAC in patients with such comorbidities and to the selection of patients for whom preventive total pancreatectomy would be beneficial.…”

Section: Discussionmentioning

confidence: 99%

Genetic assessment of recurrent pancreatic high-risk lesions in the remnant pancreas: Metachronous multifocal lesion or local recurrence?

Gotoh

Ohtsuka

Nakamura

et al. 2019

Surgery

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Background: It is difficult to determine whether a second high-risk lesion, including pancreatic ductal adenocarcinoma or high-grade pancreatic intraepithelial neoplasm, is a metachronous multifocal lesion or represents local recurrence after resection of the first high-risk lesion. This study attempts to clarify the characteristics of second high-risk lesions in the remnant pancreas using genetic analyses. Methods: Clinicopathologic data were collected from 12 patients who underwent pancreatectomy for a second high-risk lesion in the remnant pancreas. We performed mutational and immunohistochemical analyses of 4 major genes-KRAS, TP53, CDKN2A , and SMAD4-associated with pancreatic ductal adenocarcinoma progression, as well as targeted next-generation sequencing. Results: Mutations in the four genes in the second high-risk lesion were consistent with the first lesion in four patients but were inconsistent in the remaining eight patients, and thus we considered that the latter eight patients likely had metachronous multifocal high-risk lesions and the other four patients had local recurrence. The estimated cumulative recurrence rate after resection of the second high-risk lesion was greater in the local recurrence group compared with the metachronous multifocal group, and the estimated cumulative disease-specific survival rate was greater in the metachronous multifocal group. Targeted next-generation sequencing demonstrated that the second lesions in the metachronous multifocal high-risk lesion group showed differences in founder mutations compared with the first lesion. In the local recurrence group, the founder mutations in the second lesion were common with those in the first lesion. Conclusion: Genetic assessment might help discriminate metachronous multifocal high-risk lesions from local recurrence.

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“…Sin embargo, los resultados con el empleo de estas guías son subóptimos y han sido criticados por múltiples autores, especialmente las recomendaciones de la AGA acerca de interrumpir el seguimiento (19,30,31). El tratamiento y seguimiento de las BD-IPMN está especialmente poco aclarado (9,19,30,32,33).…”

Section: Diagnósticounclassified

Neoplasias quísticas pancreáticas, enfoque diagnóstico

Pérez

Morena

Santander-Vaquero

2019

Rev Colomb Gastroenterol

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Los quistes pancreáticos comprenden una amplia variedad de lesiones cada vez más frecuentemente diagnosticadas debido tanto al empleo creciente de técnicas de imagen como al envejecimiento de la población. Entre ellas, las neoplasias quísticas mucinosas son especialmente relevantes por su potencial de malignización. Aunque la ecografía abdominal, la tomografía axial computarizada y la resonancia magnética suelen ser las pruebas diagnósticas de imagen iniciales, muchas veces los hallazgos morfológicos no son suficientes para su diferenciación. La ecoendoscopia se ha convertido en la mejor prueba para su caracterización ya que permite realizar estudio morfológico y también del líquido obtenido mediante punción, aunque su precisión diagnóstica para la detección de quistes de estirpe mucinosa y de malignidad sigue siendo baja. La importancia de la adecuada caracterización radica tanto en la detección precoz de las lesiones preneoplásicas y malignas como en evitar cirugías innecesarias. La indicación de ecoendoscopia, de tratamiento quirúrgico y de seguimiento varía entre las distintas guías de práctica clínica estando actualmente en duda especialmente el tratamiento y seguimiento de las neoplasias quísticas mucinosas papilares intraductales de rama lateral por el menor riesgo de degeneración y su asociación con el cáncer de páncreas.

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Surveillance of patients with intraductal papillary mucinous neoplasm with and without pancreatectomy with special reference to the incidence of concomitant pancreatic ductal adenocarcinoma

Cited by 25 publications

References 29 publications

Subtype of intraductal papillary mucinous neoplasm of the pancreas is important to the development of metachronous high-risk lesions after pancreatectomy

Subtype of intraductal papillary mucinous neoplasm of the pancreas is important to the development of metachronous high-risk lesions after pancreatectomy

Genetic assessment of recurrent pancreatic high-risk lesions in the remnant pancreas: Metachronous multifocal lesion or local recurrence?

Neoplasias quísticas pancreáticas, enfoque diagnóstico

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