Treatment Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas Based on the Assessment of Recurrence in the Remnant Pancreas After Resection

Tamura, Koji; Ohtsuka, Takao; Ideno, Noboru; Aso, Teijiro; Shindo, Koji; Aishima, Shinichi; Ohuchida, Kenoki; Takahata, Shunichi; Ushijima, Yasuhiro; Ito, Tetsuhide; Oda, Yoshinao; Mizumoto, Kazuhiro; Tanaka, Masao

doi:10.1097/sla.0b013e3182a690ff

Cited by 76 publications

(66 citation statements)

References 31 publications

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“…At present, only invasive carcinoma derived from IPMN is considered malignant, and high-grade dysplasia is not considered malignant [4,6]. However, this has recently been questioned, as there have been some reported cases of high-grade dysplasia recurring as a distant metastasis after resection [8,9]. High-grade dysplasia is regarded as an indication for surgical resection as stated in the Fukuoka guidelines [4], although it is not clearly defined as malignant [6].…”

Section: Definitions and Classificationmentioning

confidence: 99%

“…Ideno et al [67] investigated the histological subtype of IPMN in patients with concomitant pancreatic cancer, and found a high frequency of gastric subtype. Concomitant pancreatic cancer may occur in patients with MD-IPMN as well as BD-IPMN [8]. Furthermore, distinct pancreatic cancer may develop even after the resection of IPMN.…”

Section: Invasive Pancreatic Cancer Concomitant With Ipmnmentioning

confidence: 99%

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Thirty Years of Experience with Intraductal Papillary Mucinous Neoplasm of the Pancreas: From Discovery to International Consensus

Tanaka¹

2014

Digestion

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Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin-producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified as the main duct type (MD-IPMN) and the branch duct type (BD-IPMN) according to the location of involvement, and into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to the histomorphological and immunohistochemical characteristics. Mucin core protein expression correlates with the biological behavior and prognosis of the tumor. DNA analysis has shown that IPMN is associated with a number of gene mutations, but the roles of many of these mutations require further investigation. Most patients with MD-IPMN undergo tumor resection. Patients with BD-IPMN who do not undergo resection may develop malignant change, and concomitant separate pancreatic cancer occurs in 2-10% of patients with IPMN. Patients with a strong family history may develop multiple BD-IPMNs as well as concomitant pancreatic cancer. Malignant changes are relatively easy to detect, especially by endoscopic ultrasonography (EUS), but the optimal surveillance protocol is currently unclear. Key Messages: The 2012 guidelines for the management ofIPMN recommend that patients with ‘high-risk stigmata' (obstructive jaundice, enhanced solid component, and main pancreatic duct size ≥10 mm) should undergo resection. Patients with ‘worrisome features' (cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, main pancreatic duct size 5-9 mm, abrupt change in main pancreatic duct caliber with distal pancreatic atrophy, lymphadenopathy, and clinical acute pancreatitis) should be evaluated by EUS. EUS is a more sensitive test than computed tomography or magnetic resonance imaging for the early detection of malignancy. Conclusions: Most patients with MD-IPMN should undergo tumor resection. Patients with BD-IPMN who do not undergo resection should undergo careful surveillance including EUS for the early detection of malignant change and separate pancreatic cancer.

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Section: Definitions and Classificationmentioning

confidence: 99%

Section: Invasive Pancreatic Cancer Concomitant With Ipmnmentioning

confidence: 99%

Thirty Years of Experience with Intraductal Papillary Mucinous Neoplasm of the Pancreas: From Discovery to International Consensus

Tanaka¹

2014

Digestion

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“…Besides recurrence of invasive IPMN, several investigators have reported recurrent lesions after resection of noninvasive IPMN 39, 40, 41, 42, 43, 44. We also experienced peritoneal dissemination after resection of high‐grade IPMN 7. Even after resection of noninvasive IPMN, especially high‐grade IPMN, attention should be paid to the development of recurrent lesions.…”

Section: Surveillance After Resection Of Ipmnmentioning

confidence: 79%

“…IPMN comprises main duct type (MD‐IPMN), branch duct type (BD‐IPMN), and mixed type (MD + BD). MD‐IPMN more frequently progresses to malignant lesions (60‐70%)2, 5, 6, 7 than BD‐IPMN,2, 5, 8 although BD‐IPMN is more commonly seen than MD‐IPMN 9, 10. Researchers have also hypothesized that benign BD‐IPMN may develop distinct pancreatic ductal adenocarcinoma (PDAC) synchronously or metachronously.…”

Section: Introductionmentioning

confidence: 99%

Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines?

Nakamura

Miyasaka

Sadakari

et al. 2017

Annals of Gastroent Surgery

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Management of intraductal papillary mucinous neoplasm is controversial, and several guidelines have aimed to establish an adequate strategy for surgical resection and surveillance. We compared various intraductal papillary mucinous neoplasm guidelines and considered new matters that are pivotal for improved treatment of intraductal papillary mucinous neoplasm. We identified and compared 11 published guidelines, three of which were major guidelines that mainly referred to the diagnosis and treatment of intraductal papillary mucinous neoplasm (International Association of Pancreatology 2012 guidelines, European Study Group on Cystic Tumours of the Pancreas 2013 guidelines, and American Gastroenterological Association 2015 guidelines). The main concerns of these three guidelines were indication for surgery and follow up of non‐resected lesions. Among the differences between the three guidelines, the period of surveillance recommended was the most controversial matter. Meanwhile, several nomograms have been proposed to improve the diagnosis of intraductal papillary mucinous neoplasm from the level of experts' experiences to that of rational systems. We discuss the adequate strategy of surveillance for intraductal papillary mucinous neoplasm with and without pancreatectomy and nomograms aiming to predict the risk of malignancy in patients with intraductal papillary mucinous neoplasm.

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“…Surgeons often encounter difficulties in determining the extent of resection, in particular for patients with main duct-type IPMN, even when using intraoperative ultrasonography (IOUS) [17,18,19]. Furthermore, neoplasms with low malignant potential, such as IPMN, appear to present an adequate indication of laparoscopic surgery with navigation surgery technology because of the lack of tactile or three-dimensional (3D) sensation [4,20,21].…”

Section: Introductionmentioning

confidence: 99%

Navigation Surgery Using an Augmented Reality for Pancreatectomy

et al. 2015

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Aim: The aim of this study was to evaluate the utility of navigation surgery using augmented reality technology (AR-based NS) for pancreatectomy. Methods: The 3D reconstructed images from CT were created by segmentation. The initial registration was performed by using the optical location sensor. The reconstructed images were superimposed onto the real organs in the monitor display. Of the 19 patients who had undergone hepatobiliary and pancreatic surgery using AR-based NS, the accuracy, visualization ability, and utility of our system were assessed in five cases with pancreatectomy. Results: The position of each organ in the surface-rendering image corresponded almost to that of the actual organ. Reference to the display image allowed for safe dissection while preserving the adjacent vessels or organs. The locations of the lesions and resection line on the targeted organ were overlaid on the operating field. The initial mean registration error was improved to approximately 5 mm by our refinements. However, several problems such as registration accuracy, portability and cost still remain. Conclusion: AR-based NS contributed to accurate and effective surgical resection in pancreatectomy. The pancreas appears to be a suitable organ for further investigations. This technology is promising to improve surgical quality, training, and education.

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Treatment Strategy for Main Duct Intraductal Papillary Mucinous Neoplasms of the Pancreas Based on the Assessment of Recurrence in the Remnant Pancreas After Resection

Cited by 76 publications

References 31 publications

Thirty Years of Experience with Intraductal Papillary Mucinous Neoplasm of the Pancreas: From Discovery to International Consensus

Thirty Years of Experience with Intraductal Papillary Mucinous Neoplasm of the Pancreas: From Discovery to International Consensus

Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines?

Navigation Surgery Using an Augmented Reality for Pancreatectomy

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