Cirugía General, Clínica Universidad de Navarra, España.
Cirugía/ Apoyo Investigación, Clinica Universidad de Navarra, España.
Rev Esp Enferm Dig. 2018 Dec;110(12):768-774. doi: 10.17235/reed.2018.5646/2018.
the objective of this study was to analyze the anatomical and clinical features and long-term oncologic outcomes of 25 patients that underwent surgery due to intraductal papillary mucinous neoplasm of the pancreas.
patients undergoing surgery for intraductal papillary mucinous neoplasm of the pancreas were identified from a prospective database of pancreatic resections. Demographic data, symptoms, type of surgery and type of lesion (branch type, main duct or mixed) were recorded. The lesions were classified into invasive (high grade dysplasia and carcinoma) and noninvasive (low- or intermediate-grade dysplasia). Postoperative complications were analyzed as well as the pattern of recurrence and disease-free survival at five and ten years.
the most common symptoms in the 25 patients (14 males and eleven females) were abdominal pain and weight loss. Eight (32%) cases were diagnosed incidentally. Twelve (48%) of the lesions were of the branch type, three affected the main duct and ten (40%) were mixed. Twelve cephalic duodenopancreatectomies and seven total pancreatectomies were performed; three were central; two, distal; and one, enucleation. Seven cases (32%) had an invasive phenotype. Three patients had locoregional and distant recurrence at six, 16 and 46 months after surgery with a median follow-up of 7.7 years. Disease-free survival at five and ten years for the noninvasive type was 94% and 57% for invasive phenotypes (p < 0.05).
intraductal papillary mucinous neoplasm is a heterogeneous entity with well differentiated phenotypes, which requires a tailored strategy and treatment, as established in the current consensus guidelines due to its malignant potential.
本研究旨在分析 25 例行胰腺导管内乳头状黏液性肿瘤（IPMN）手术患者的解剖学和临床特征及长期肿瘤学结果。
从胰腺切除术的前瞻性数据库中确定因胰腺导管内乳头状黏液性肿瘤而行手术的患者。记录患者的人口统计学数据、症状、手术类型和病变类型（分支型、主胰管型或混合型）。将病变分为侵袭性（高级别异型增生和癌）和非侵袭性（低级别或中级别异型增生）。分析术后并发症以及 5 年和 10 年的复发模式和无病生存率。
25 例患者（14 例男性和 11 例女性）最常见的症状是腹痛和体重减轻。8 例（32%）为偶然诊断。12 例（48%）病变为分支型，3 例影响主胰管，10 例（40%）为混合型。行 12 例胰头十二指肠切除术和 7 例全胰切除术；3 例为中央型，2 例为远端型，1 例为剜除术。7 例（32%）为侵袭性表型。3 例患者在术后 6、16 和 46 个月出现局部和远处复发，中位随访时间为 7.7 年。非侵袭性表型的 5 年和 10 年无病生存率分别为 94%和 57%，侵袭性表型分别为 57%和 29%（p<0.05）。
IPMN 是一种具有良好分化表型的异质性实体，由于其恶性潜能，需要根据当前共识指南制定个体化的策略和治疗方法。
