Clinicopathological features and medical management of intraductal papillary mucinous neoplasms
| Autor: | Takuhiro Kosaki, Ken Okamoto, Saburo Onishi, Isao Nishimori, Keijiro Araki, Michiya Kobayashi, Takeki Sugimoto, Nobuto Okamoto, Takehiro Okabayashi, Tsutomu Namikawa |
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| Rok vydání: | 2006 |
| Předmět: |
Endoscopic ultrasound
Adult Male medicine.medical_specialty Time Factors endocrine system diseases medicine.medical_treatment Gastroenterology Endosonography Diagnosis Differential Carcinoembryonic antigen Pancreatectomy Internal medicine medicine Carcinoma Humans Aged Retrospective Studies Pancreatic duct Aged 80 and over Cholangiopancreatography Endoscopic Retrograde Hepatology Intraductal papillary mucinous neoplasm medicine.diagnostic_test biology business.industry Carcinoma in situ Middle Aged medicine.disease Adenocarcinoma Mucinous Pancreatic Neoplasms medicine.anatomical_structure Treatment Outcome biology.protein Adenocarcinoma Female business Follow-Up Studies |
| Zdroj: | Journal of gastroenterology and hepatology. 21(2) |
| ISSN: | 0815-9319 |
| Popis: | Background: Intraductal papillary mucinous neoplasms (IPMN) are a clinicopathological entity that is being diagnosed with increasing frequency. However, the best approach to medical management of IPMN needs to be clarified. The aim of the present study was to identify preoperative features that may be predictors of malignant IPMN, and to define the medical management of IPMN of the pancreas. Methods: A total of 23 patients who underwent surgical resection for IPMN of the pancreas at Kochi Medical School between 1982 and 2004 were examined. Multivariate Cox regression analysis was used to identify factors independently associated with IPM carcinoma. Results: Among the 23 patients, 12 had IPMN adenoma, three had borderline IPMN, four had IPMN with carcinoma in situ, and four had IPMN with invasive carcinoma. In multivariate analysis, elevated serum carcinoembryonic antigen (CEA) and carbohydrate antigen (CA) 19-9 levels were found to be preoperative predictors of malignant IPMN. These results suggest that the following IPMN of the pancreas should be resected: (i) IPMN of the pancreas situated in the main duct; (ii) IPMN located in the branch duct if the size of the cystic lesion is >30 mm and the mural nodules are >5 mm in height by endoscopic ultrasound (EUS); and (iii) the diameter of the main pancreatic duct is >10 mm by endoscopic retrograde pancreatography (ERP). Careful observation of patients with branch-type IPMN with small cysts and/or without mural nodules is recommended as a management strategy. Conclusion: The present study reinforces the need for immediate surgical resection of malignant IPMN and suggests indicators for IPMN that should assist physicians in making decisions on treatment options. © 2005 Blackwell Publishing Asia Pty Ltd |
| Databáze: | OpenAIRE |
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