Department of Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
Am J Surg. 2011 May;201(5):575-9. doi: 10.1016/j.amjsurg.2011.01.003.
The purpose of this study was to examine the characteristics of pancreatic intraductal papillary mucinous neoplasm (IPMN) in our institution and the selection for resection. Recent publications, including those from the International Consensus Guidelines and the Mayo Clinic, set forth criteria for resection. However, these criteria differ in the definition of main duct IPMN, which is an indication to resect.
Sixty patients from a single institution were retrospectively reviewed between 2000 and 2009.
Thirteen percent of patients had high-grade dysplasia, and 22% had invasive cancer. In multivariate analysis, factors associated with a lower risk of carcinoma were female sex (P = .039) and size <3 cm (P = .024). Patients were retrospectively evaluated with Mayo and International Consensus Guidelines. Eight patients had a diagnosis that would have changed from main duct to branch duct if the International Consensus Guidelines were used. Of these 8, there were 2 cancers. If the International Consensus Guidelines were applied instead of the Mayo, both cancers would have been resected, but 2 patients without cancer would have been spared an operation.
Twenty-two percent of resected patients had invasive cancer, and they had significantly worse survival (37 vs 85 months, P = .032). In our patient group, application of the International Consensus Guidelines identified all malignant IPMN and would have prevented 2 nontherapeutic resections when compared with the Mayo criteria.
本研究旨在分析我院胰腺导管内乳头状黏液性肿瘤（IPMN）的特征及手术适应证。近期的一些文献，包括国际共识指南和梅奥诊所的文献，都提出了手术适应证的标准。然而，这些标准对于主胰管型 IPMN 的定义有所不同，而主胰管型 IPMN 是手术切除的指征。
回顾性分析了 2000 年至 2009 年间我院收治的 60 例患者。
13%的患者存在高级别异型增生，22%的患者存在浸润性癌。多因素分析显示，女性（P =.039）和肿瘤直径<3cm（P =.024）与较低的癌变风险相关。应用梅奥和国际共识指南对患者进行回顾性评估，其中 8 例患者若应用国际共识指南，其主胰管型 IPMN 的诊断将会变为分支胰管型 IPMN，这 8 例患者中存在 2 例癌症。如果应用国际共识指南而非梅奥标准，则这 2 例癌症均需要手术切除，但有 2 例无癌患者可避免手术。
22%的手术切除患者存在浸润性癌，其生存时间明显更差（37 个月 vs 85 个月，P =.032）。在本研究中，应用国际共识指南可以发现所有恶性 IPMN，并与梅奥标准相比，可避免 2 例非治疗性手术。
