Purpose: The surgical strategy for patients with a pancreatic intraductal papillary mucinous tumor (IPMT) is still controversial. In this study the clinicopathologic findings in a series of patients were used to rationalize surgical choice
and
reassess the need for a total pancreatectomy.
Methods: Between Oct. 1994 and Nov. 2001, 25 patients with IPMT underwent surgery. We retrospectively examined the clinicopathologic features and surgical treatment. The factors evaluated included: symptoms, tumor site, operation type,
histological findings, resection margin, follow-up and survival.
Results: Pancreaticoduodenectomy was the most frequent surgical treatment (10 patients: 40%) followed by distal pancreatectomy (6), pylorus-preserving-pancreatico-duodenectomy (5) and total pancreatectomy (4). Histological assessment
revealed the
tumors to be an adenoma in 11 patients (44%), a borderline tumor in 8 patients (32%) and a carcinoma in 6 patients (24%). There were no operative or hospital deaths. All of the cases with hyperplasia, adenoma and noninvasive carcinoma survived.
Only two
of the patients with invasive carcinoma died. Mild to moderate dysplasia was present at the resection margin in two patients (8%), and carcinoma in one. A total pancreatectomy was performed in four patients. Invasive carcinoma patient survival
was
significantly associated with the presence of peri- pancreatic lymph node involvement.
Conclusions: Our study and review of the literature indicates that preoperative indicators of malignancy in IPMT are still lacking. These results suggest that resection should be the treatment for IPMT. Sometimes IPMT is best treated by a
total
pancreatectomy, although lesser subtotal resections should definitely be considered. When selecting a surgical procedure for treating these tumors, it is useful to confirm the tumors’ extent by intra-operative imaging modalities. In the cases
with
invasion, a radical resection is required.
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