Johns Hopkins Medical Institutions and the Pancreatic Cancer Precision Medicine Center of Excellence Program, Baltimore, MD, USA.
Department of Surgery, Northwell Health, Manhasset, NY, USA.
HPB (Oxford). 2022 May;24(5):645-653. doi: 10.1016/j.hpb.2021.09.013. Epub 2021 Sep 23.
Main-duct (MD) intraductal papillary mucinous neoplasm (IPMN) is associated with malignancy risk. There is a lack of consensus on treatment (partial or total pancreatectomy) when the MD is diffusely involved. We sought to characterize the pancreatic remnant fate after partial pancreatectomy for non-invasive diffuse MD-IPMN.
Consecutive patients with partial pancreatectomy for non-invasive MD-IPMN from 2004 to 2016 were analyzed. Diffuse MD-IPMN was defined by preoperative imaging as dilation of the MD in the head of the pancreas more than 5 mm and involving the whole gland.
Of 127 patients with resected non-invasive MD-IPMN, 47 (37%) had diffuse MD involvement. Eleven of 47(23%) patients developed imaging evidence of progression or new cystic disease in the pancreatic remnant. Patients with diffuse MD-IPMN were older (73yrs vs 67yrs, p = 0.009), more likely to receive a pancreaticoduodenectomy (96% vs 56%, p < 0.001) and have high-grade dysplasia (51% vs 31%, p = 0.025) than those with focal MD involvement. Diffuse MD involvement was not associated with shorter PFS following partial pancreatectomy (p = 0.613).
Partial pancreatectomy is an appropriate surgical approach for diffuse MD-IPMN, and is not associated with earlier progression after surgery as compared to partial pancreatectomy for focal dilation.
主胰管（MD）内乳头状黏液性肿瘤（IPMN）与恶性肿瘤风险相关。当 MD 弥漫性受累时，对于治疗（部分或全胰切除术）尚未达成共识。我们旨在描述非侵袭性弥漫性 MD-IPMN 行部分胰腺切除术后胰腺残端的命运。
对 2004 年至 2016 年间行部分胰腺切除术治疗非侵袭性 MD-IPMN 的连续患者进行分析。弥漫性 MD-IPMN 是指术前影像学检查显示 MD 在胰头扩张超过 5mm 且累及整个腺体。
在 127 例接受切除的非侵袭性 MD-IPMN 患者中，47 例（37%）存在弥漫性 MD 受累。47 例患者中有 11 例（23%）出现影像学证据表明胰腺残端有进展或新的囊性疾病。弥漫性 MD-IPMN 患者年龄更大（73 岁 vs 67 岁，p=0.009），更可能接受胰十二指肠切除术（96% vs 56%，p<0.001），并且存在高级别异型增生（51% vs 31%，p=0.025）的比例更高。弥漫性 MD 受累与部分胰腺切除术后 PFS 缩短无关（p=0.613）。
部分胰腺切除术是治疗弥漫性 MD-IPMN 的一种合适的手术方法，与部分胰腺切除术治疗局灶性扩张相比，弥漫性 MD-IPMN 术后进展更早无关。
