Yamao K, Ohashi K, Nakamura T, Suzuki T, Shimizu Y, Nakamura Y, Horibe Y, Yanagisawa A, Nakao A, Nimuara Y, Naito Y, Hayakawa T
Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan.
Hepatogastroenterology. 2000 Jul-Aug;47(34):1129-34.
BACKGROUND/AIMS: Intraductal papillary mucinous tumors of the pancreas have been recognized as a distinct clinical entity. However, their biological behavior has not been clearly defined. The aim of this study was to examine the prognosis of this tumor, to clarify the biological behavior and determine the most appropriate treatment.
Correlations between prognosis of operated cases and histopathologic features were investigated.
In 105 patients with characteristic clinical features of intraductal papillary mucinous tumors, the lesions were classified as hyperplasias in 21%, intraductal tumors in 48% and invasive carcinomas in 31%. Minimal invasion was apparent in 25%, lymph node metastasis in 21%, and fistula formation in 31% of the invasive lesions. Non-invasive and minimally invasive intraductal papillary mucinous tumors were essentially free from risk of tumor recurrence. Other invasive intraductal papillary mucinous tumors showed a significantly poor prognosis.
Because of the variation in pathological characteristics, patient outcome and the possibility of differential diagnosis, the treatment might be recommended as follows: the case of hyperplasia can be followed-up with close surveillance. Non-invasive and minimally invasive intraductal papillary mucinous tumors should be operated with function-preserving minimal pancreatectomy. For patients with invasive intraductal papillary mucinous tumors evident with preoperative imaging modalities, radical operations with lymph node dissection might be needed.
背景/目的：胰腺导管内乳头状黏液性肿瘤已被确认为一种独特的临床实体。然而，其生物学行为尚未明确界定。本研究的目的是探讨该肿瘤的预后，阐明其生物学行为并确定最合适的治疗方法。
研究手术病例的预后与组织病理学特征之间的相关性。
105例具有胰腺导管内乳头状黏液性肿瘤特征性临床症状的患者中，病变分类为增生的占21%，导管内肿瘤的占48%，浸润性癌的占31%。25%的浸润性病变存在微小浸润，21%有淋巴结转移，31%有瘘管形成。非侵袭性和微侵袭性胰腺导管内乳头状黏液性肿瘤基本无肿瘤复发风险。其他侵袭性胰腺导管内乳头状黏液性肿瘤的预后则明显较差。
由于病理特征、患者预后存在差异以及鉴别诊断的可能性，建议如下治疗方案：增生病例可密切随访观察。非侵袭性和微侵袭性胰腺导管内乳头状黏液性肿瘤应行保留功能的胰腺部分切除术。对于术前影像学检查显示为侵袭性胰腺导管内乳头状黏液性肿瘤的患者，可能需要行根治性手术并清扫淋巴结。
