Interdisciplinary management of an intraductal papillary mucinous neoplasm of the pancreas.
Interdisciplinary management of an intraductal papillary mucinous neoplasm of the pancreas.
复制标题
胰腺导管内乳头状粘液性肿瘤的跨学科治疗。
DOI：
10.1177/107327480801500407
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
M. Malafa
中科院分区：
文献类型：
--
作者：
Rajesh M. Nair;J. Barthel;B. Centeno;Junsung Choi;J. Klapman;M. Malafa
背景
胰腺导管内乳头状粘液性肿瘤（IPMN）比经典的胰腺浸润性导管腺癌少见，但由于其临床病理特征现已明确，因此诊断频率更高。IPMN通常沿着胰管存在多灶性，与复发的显著风险相关，即使在边缘阴性切除后也需要警惕监测。
方法
作者提出了一个突出的重要特点，在诊断，检查和管理的IPMN的情况下。他们还回顾了现有的文献，重点介绍了流行病学，分子研究的结果和目前的治疗建议。
结果
医生和患者必须仔细权衡与治疗方案相关的风险和收益。对于多病灶性病变的可能性高的患者，有限切除可保留胰腺实质并降低胰腺内分泌和外分泌功能不全的风险。虽然在残余物中发展浸润性癌症的风险很小，但如果它确实发展，预后会更差。相反，全胰腺切除术消除了未来恶性肿瘤的风险，但涉及终身胰岛素和外源性胰酶依赖和显着相关的发病率。
结论
有效治疗IPMN的决策是复杂的，需要一个具有诊断和管理这些肿瘤经验的跨学科团队关注细节。治疗必须根据患者的剩余寿命和整体质量进行个性化。这些病变的分子特征分析可能允许在未来更精确地定制治疗。
BACKGROUND
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is less common than classic invasive ductal adenocarcinoma of the pancreas but is being diagnosed with greater frequency since its clinicopathologic features are now clearly defined. Often multifocal in its existence along the pancreatic duct, IPMN is associated with a significant risk for recurrence and warrants vigilant surveillance, even after a margin-negative resection.
METHODS
The authors present a case highlighting important features in the diagnosis, workup, and management of IPMN. They also review existing literature highlighting epidemiology, findings of molecular studies, and current treatment recommendations.
RESULTS
Physicians and patients must carefully weigh the risks and benefits associated with treatment options. Limited resection in a patient with a high likelihood of multifocal disease preserves pancreatic parenchyma and reduces the risk of developing pancreatic endocrine and exocrine insufficiency. Though the risk of developing invasive cancer in the remnant is small, the prognosis is worse if it does develop. Conversely, total pancreatectomy eliminates the risk of future malignancy but involves life-long insulin and exogenous pancreatic enzyme dependence and significant associated morbidity.
CONCLUSIONS
Decision making for effective treatment of IPMN is complex and requires attention to detail by an interdisciplinary team with experience in the diagnosis and management of these tumors. Treatment must be individualized based on patient life expectancy in terms of remaining years and overall quality. Molecular profiling of these lesions may allow for more precise tailoring of treatment in the future.