Daudé Mathieu, Muscari Fabrice, Buscail Camille, Carrère Nicolas, Otal Philippe, Selves Janick, Buscail Louis, Bournet Barbara
Mathieu Daudé, Louis Buscail, Barbara Bournet, Department of Gastroenterology, CHU Toulouse Rangueil, University of Toulouse, 31059 Toulouse, France.
World J Gastroenterol. 2015 Mar 7;21(9):2658-67. doi: 10.3748/wjg.v21.i9.2658.
To compare characteristics and outcomes of resected and nonresected main-duct and mixed intraductal papillary mucinous neoplasms of the pancreas (IPMN).
Over a 14-year period, 50 patients who did not undergo surgery for resectable main-duct or mixed IPMN, for reasons of precluding comorbidities, age and/or refusal, were compared with 74 patients who underwent resection to assess differences in rates of survival, recurrence/occurrence of malignancy, and prognostic factors. All study participants had dilatation of the main pancreatic duct by ≥ 5 mm, with or without dilatation of the branch ducts. Some of the nonsurgical patients showed evidence of mucus upon perendoscopic retrograde cholangiopancreatography or endoscopic ultrasound and/or after fine needle aspiration. For the surgical patients, pathologic analysis of resected specimens confirmed a diagnosis of IPMN with involvement of the main pancreatic duct or of both branch ducts as well as the main pancreatic duct. Clinical and biologic follow-ups were conducted for all patients at least annually, through hospitalization or consultation every six months during the first year of follow-up, together with abdominal imaging analysis (magnetic resonance cholangiopancreatography or computed tomography) and, if necessary, endoscopic ultrasound with or without fine needle aspiration.
The overall five-year survival rate of patients who underwent resection was significantly greater than that for the nonsurgical patients (74% vs 58%; P = 0.019). The parameters of age (< 70 years) and absence of a nodule were associated with better survival (P < 0.05); however, the parameters of main pancreatic duct diameter > 10 mm, branch duct diameter > 30 mm, or presence of extra pancreatic cancers did not significantly influence the prognosis. In the nonsurgical patients, pancreatic malignancy occurred in 36% of cases within a mean time of 33 mo (median: 29 mo; range: 8-141 mo). Comparison of the nonsurgical patients who experienced disease progression with those who did not progress showed no significant differences in age, sex, symptoms, subtype of IPMN, or follow-up period; only the size of the main pancreatic duct was significantly different between these two sub-groups, with the nonsurgical patients who experienced progression showing a greater diameter at the time of diagnosis (> 10 mm).
Patients unfit for surgery have a 36% greater risk of developing pancreatic malignancy of the main-duct or mixed IPMN within a median of 2.5 years.
比较胰腺导管内乳头状黏液性肿瘤（IPMN）主胰管型和混合型行手术切除与未切除患者的特征及预后。
在14年期间，将50例因合并症、年龄及/或拒绝手术等原因未对可切除的主胰管型或混合型IPMN进行手术的患者，与74例行手术切除的患者进行比较，以评估生存率、恶性肿瘤复发/发生几率及预后因素的差异。所有研究参与者的主胰管均扩张≥5mm，伴或不伴有分支胰管扩张。部分非手术患者在内镜逆行胰胆管造影术、内镜超声检查及/或细针穿刺后显示有黏液迹象。对于手术患者，切除标本的病理分析证实为IPMN，累及主胰管或同时累及分支胰管及主胰管。对所有患者至少每年进行临床及生物学随访，随访第一年每6个月通过住院或会诊进行，同时进行腹部影像学分析（磁共振胰胆管造影术或计算机断层扫描），必要时进行内镜超声检查及/或细针穿刺。
手术患者的总体五年生存率显著高于非手术患者（74%对58%；P = 0.019）。年龄（<70岁）及无结节等参数与较好的生存率相关（P < 0.05）；然而，主胰管直径>10mm、分支胰管直径>30mm或存在胰腺外癌症等参数对预后无显著影响。在非手术患者中，36%的病例在平均33个月（中位数：29个月；范围：8 - 141个月）内发生胰腺恶性肿瘤。将疾病进展的非手术患者与未进展的患者进行比较，发现年龄、性别、症状、IPMN亚型或随访时间无显著差异；仅这两个亚组之间的主胰管大小有显著差异，疾病进展的非手术患者在诊断时直径更大（>10mm）。
不适合手术的患者在中位数2.5年内发生主胰管型或混合型IPMN胰腺恶性肿瘤的风险高36%。
