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Pancreatic Resection for Side-Branch Intraductal Papillary Mucinous Neoplasm (SB-IPMN): a Contemporary Single-Institution Experience

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Given the malignant potential of main duct intraductal papillary mucinous neoplasm (M-IPMN), surgical resection is generally indicated. With regard to side-branch intraductal papillary mucinous neoplasm (SB-IPMN), resection vs. observation is a topic of debate. Further review of SB-IPMN is necessary to clarify appropriate management. The primary focus of this project is to determine the incidence of malignant final pathology for patients undergoing surgery for isolated SB-IPMN with non-malignant fine-needle aspiration (FNA) cytology. We also sought to describe the relationship between factors considered in the international consensus guidelines and final pathologic outcome.

Methods

The study is a retrospective review of all patients who underwent surgical resection for intraductal papillary mucinous neoplasm (IPMN) from 2002 to 2013 at our institution. Patients with a preoperative diagnosis of isolated SB-IPMN and FNA results for non-malignant cytology were selected among this surgical cohort for further analysis of preoperative clinical characteristics and outcomes.

Results

A total of 137 patients undergoing resection for IPMN were identified. Of these, 81 patients (59 %) had a component of M-IPMN or invasive disease on FNA, leaving 66 (46 %) patients with SB-IPMN and non-malignant cytology. Invasive adenocarcinoma was found in 8/66 (12 %) patients and high-grade dysplasia (HGD) in 4/66 (8 %) patients. The mean [SD] diameter of benign SB-IPMN was 2.0 cm [1.1] (range 0.3–5.7) vs. that of HGD/invasive disease which was 3.1 cm [1.3] (range 1.5–6.0; P = 0.014). Of the 12 patients found to have HGD or invasive disease, symptoms, mural nodules, and septations were found in 7 (58 %), 5 (42 %), and 6 (50 %), respectively. Tumor staging were as follows: IA (2), IB (2), 2A (4), and 2B (1).

Conclusion

With proper selection criteria, SB-IPMN is associated with a low rate of invasive pancreatic ductal adenocarcinoma at the time of resection. Nevertheless, given the demonstrated incidence of malignancy, appropriate operative candidates should undergo resection.

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Financial and Material Support

No external financial or material support was provided for this study.

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Conflict of Interest

The authors declare no competing interest.

Authors’ Contribution

Dr. Dortch had full access to all the data in the study and takes responsibility for the integrity of the data, accuracy of the data analysis, and drafting of the manuscript. Dortch, Stauffer, and Asbun are responsible for the concept and design of the study and the critical revision of the manuscript for important intellectual content. Dortch, Stauffer, Asbun, Bhupendra Rawal, and M.S. are responsible for the acquisition, analysis, or interpretation of data.

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Authors and Affiliations

  1. Department of General Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    John D. Dortch, John A. Stauffer & Horacio J. Asbun

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  1. John D. Dortch
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  2. John A. Stauffer
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  3. Horacio J. Asbun
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Correspondence to Horacio J. Asbun.

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Dortch, J.D., Stauffer, J.A. & Asbun, H.J. Pancreatic Resection for Side-Branch Intraductal Papillary Mucinous Neoplasm (SB-IPMN): a Contemporary Single-Institution Experience. J Gastrointest Surg 19, 1603–1609 (2015). https://doi.org/10.1007/s11605-015-2851-y

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