Segmental versus diffuse main duct intraductal papillary mucinous neoplasm: Examination of main pancreatic duct morphology and implications for malignancy risk and extent of surgical resection Journal Article

   

Authors:	Ecker, B. L.; Dickinson, S. M.; Saadat, L. V.; Tao, A. J.; Pulvirenti, A.; Balachandran, V. P.; D'Angelica, M. I.; Drebin, J. A.; Kingham, T. P.; Jarnagin, W. R.; Wei, A. C.; Gonen, M.; Soares, K. C.
Article Title:	Segmental versus diffuse main duct intraductal papillary mucinous neoplasm: Examination of main pancreatic duct morphology and implications for malignancy risk and extent of surgical resection
Abstract:	Objective: To determine whether the morphologic features of the main pancreatic duct (MPD) of main-duct-involved-intraductal papillary mucinous neoplasm (IPMN) (ie, main duct or mixed main duct/side branch) have implications for the risk of malignancy and extent of resection. Background: International consensus guidelines acknowledge the presence of various MPD morphologies (ie, diffuse vs segmental main-duct-involved-IPMN) without a precise definition of each entity and with limited data to guide treatment strategy. Methods: All consecutive main-duct-involved-IPMN patients (2005-2019) with a MPD diameter ≥5 mm by cross-sectional imaging were reviewed from a prospective institutional database. Morphologic features of the MPD were correlated with the identification of high-grade dysplasia or pancreatic ductal adenocarcinoma (HGD/PDAC) by logistic regression modeling. In patients who underwent partial pancreatectomy, preoperative MPD morphologic features were correlated with the future development of HGD/PDAC in the pancreatic remnant by Cox hazards modeling. Results: In a cohort of 214 main-duct-involved-IPMN patients, the overall rate of HGD/PDAC was 54.2%. MPD morphologic characteristics associated with HGD/PDAC included: maximal MPD diameter (5-10 mm: 29.8%; 10-14 mm: 59.0%; 15-19 mm: 78.6%; ≥20 mm: 95.8%; P<0.001), segmental extent of maximal dilation (<25%: 28.2%; 25%-49%: 54.9%; 50%-74%: 63.1%; ≥75%: 67.9%; P=0.002), and nonsegmental MPD diameter (<5 mm: 21.5% vs ≥5 mm: 78.5%, P<0.001). Diffuse MPD dilation involving ≥90% extent was rare (5.6%). After a median follow-up of 50 months, 7 (7.2%) patients who underwent partial pancreatectomy for IPMN without associated PDAC developed HGD/PDAC in the pancreatic remnant. Maximal MPD diameter, segmental extent of maximal dilation, or nonsegmental MPD diameter were not associated with the development of HGD/PDAC in the pancreatic remnant. However, a mural nodule on preoperative imaging was associated with the development of HGD/PDAC in the pancreatic remnant. Conclusions: "Diffuse"involvement with homogenous dilation of the MPD was rare. For the majority of patients with segmental main-duct-involved-IPMN, the MPD morphology conferred malignancy risk. Duct morphology was not predictive for the development of HGD or invasive disease in the pancreatic remnant, implying the safety of limited pancreatic resection for initial surgical management. Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Keywords:	adult; aged; cancer surgery; retrospective studies; major clinical study; cancer risk; pancreatic neoplasms; nuclear magnetic resonance imaging; follow up; cancer diagnosis; preoperative evaluation; prospective study; prospective studies; pancreaticoduodenectomy; computer assisted tomography; logistic models; intraductal papillary mucinous tumor; carcinoma, pancreatic ductal; cohort analysis; pathology; retrospective study; pancreas carcinoma; pancreatitis; pancreas tumor; pancreatic ducts; pancreatectomy; jaundice; statistical model; morphological trait; distal pancreatectomy; dysplasia; endoscopic retrograde cholangiopancreatography; surgical patient; surgical margin; pancreatic cyst; pancreatic ductal carcinoma; endoscopic ultrasonography; magnetic resonance cholangiopancreatography; ipmn; pancreatic carcinoma; total pancreatectomy; humans; human; male; female; article; pancreatoduodenectomy; pancreatic duct; pancreatic intraductal neoplasms; high grade dysplasia; pancreatic intraductal neoplasia
Journal Title:	Annals of Surgery
Volume:	278
Issue:	1
ISSN:	0003-4932
Publisher:	Lippincott Williams & Wilkins
Date Published:	2023-07-01
Start Page:	110
End Page:	117
Language:	English
DOI:	10.1097/sla.0000000000005672
PUBMED:	35950775
PROVIDER:	scopus
PMCID:	PMC9918598
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85162750220&doi=10.1097%2fSLA.0000000000005672&partnerID=40&md5=f16989d8c73e62c896f4393e92d1b0d6
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Kevin C. Soares -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/207950