Working Group of the Japan Pancreas Society, Japan.
Pancreas. 2011 Apr;40(3):364-70. doi: 10.1097/MPA.0b013e31820a5975.
The aim of this study was to evaluate the long-term follow-up results of patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) without mural nodules (MNs) at 10 representative institutions in Japan.
We analyzed 349 follow-up BD-IPMN patients who had no MNs on endoscopic ultrasonography at initial diagnosis.
Observation periods ranged from 1 to 16.3 years (median, 3.7 years). Sixty-two (17.8%) patients exhibited disease progression during follow-up. Twenty-two underwent surgery, leading to a pathological diagnosis of carcinoma in 9 and adenoma in 13. Although the remaining 287 (82.2%) showed no changes, 7 underwent surgery because of symptoms (n = 2), choice (n = 2), or development of pancreatic ductal adenocarcinoma (n = 3); all of them were diagnosed pathologically as adenomas. Of the 29 patients undergoing surgery, all 9 with carcinoma exhibited signs of progression, such as increased main pancreatic duct diameter and/or appearance of MNs. Pancreatic ductal adenocarcinomas and additional BD-IPMNs developed in 7 (2.0%) and 13 (3.7%), respectively. Overall, 320 (91.7%) patients were followed without surgery.
Most BD-IPMN patients who had no MNs on endoscopic ultrasonography could be managed without surgery. However, careful attention should be paid to disease progression and the development of pancreatic ductal adenocarcinomas during follow-up.
本研究旨在评估日本 10 家代表性机构中无壁结节（MNs）的分支胰管内乳头状黏液性肿瘤（BD-IPMNs）患者的长期随访结果。
我们分析了 349 例在初始诊断时内镜超声检查无 MNs 的随访 BD-IPMN 患者。
观察期为 1 至 16.3 年（中位数为 3.7 年）。62 例（17.8%）患者在随访期间出现疾病进展。22 例接受了手术，其中 9 例病理诊断为癌，13 例为腺瘤。虽然其余 287 例（82.2%）无变化，但由于症状（n=2）、选择（n=2）或发展为胰腺导管腺癌（n=3），7 例仍接受了手术；所有患者均经病理诊断为腺瘤。29 例手术患者中，所有 9 例癌均有进展迹象，如主胰管直径增大和/或出现 MNs。7 例（2.0%）发生胰腺导管腺癌，13 例（3.7%）发生额外的 BD-IPMN。总的来说，320 例（91.7%）患者未手术随访。
大多数在超声内镜检查中无 MNs 的 BD-IPMN 患者无需手术即可治疗。然而，在随访过程中应密切注意疾病进展和胰腺导管腺癌的发生。
