Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms
Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms
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DOI：
10.1016/j.surg.2015.11.003
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发表时间：
2016-04-01
期刊：
影响因子：
3.8
通讯作者：
Falconi, Massimo
中科院分区：
文献类型：
--
作者：
Crippa, Stefano;Pergolini, Ilaria;Falconi, Massimo
背景主胰管（MPD）节段性/弥漫性扩张是联合/主胰管内乳头状黏液性肿瘤（CMD-IPMN）的典型特征。IPMN的MPD扩张也可能是粘液分泌过多/阻塞性慢性胰腺炎（OCP）的表现。本研究的目的是评估肿瘤/OCP累及MPD的存在和范围，并评估过度治疗的风险。纳入了对2009年1月至2014年10月期间切除的疑似CMD-IPMN的回顾性分析。探讨MPD扩张、IPMN和OCP之间的病理相关性。总体而言，93名患者因疑似ClVID-IPMN而被切除。在病理学上，在69名患者（74%）中发现了CIVID-IPMN。8例（9%）发现分支导管IPMN（BD IPMN），9例（10%）无IPMN的胰腺导管腺癌（PDAC），1例（1%）囊性神经内分泌肿瘤（NET G2），2例（2%）浆液性囊腺瘤，4例（4%）仅OCP/粘液性化生。总体而言，18例患者（19%）因不必要（2例BD-IPMN、2例浆液性囊腺瘤和4例仅OCP）或切除范围过大（9例CMD-IPMN和1例PDAC伴OCP）而接受过度治疗。其中，全胰腺切除术是最常见的手术（67%）。IPMN受累区MPD的中位直径为12 mm，而仅发现OCP时为7 mm（P
Background. Segmental/diffuse dilatation of the main pancreatic duct (MPD) is the typical feature of combined/main-duct intraductal papillary mucinous neoplasms (CMD-IPMNs). MPD dilation in IPMNs may be also expression of mucus hypersecretion/obstructive chronic pancreatitis (OCP). The aim of this study was to evaluate the presence and extension of MPD involvement by tumor/OCP and assess the risk of overtreatment.Methods. Retrospective analysis of suspected CMD-IPMNs resected between January 2009 and October 2014 were included. Pathologic correlations among MPD dilatation, IPMN, and OCP was searched.Results. Overall, 93 patients were resected for suspected ClVID-IPMNs. At pathology, CIVID-IPMNs were found in 69 patients (74%). Branch-duct IPMNs (BD IPMNs) were found in 8 cases (9%), pancreatic ductal adenocarcinoma (PDAC) in absence of IPMN in 9 (10%), cystic neuroendocrine tumor (NET G2) in 1 (1 %), serous cystadenoma in 2 (2%), and OCP alone/mucinous metaplasia in 4 patients (4%). Overall, 18 patients (19%) underwent an overtreatment because unnecessary (2 BD-IPMNs, 2 serous cystadenomas, and 4 OCPs only) or too extensive resections (9 CMD-IPMNs and 1 PDAC with associated OCP). In these, total pancreatectomy was the most common procedure (67%). Median size of MPD in IPMN-involved area was 12 mm compared with 7 mm when only OCP was found (P