Management Strategy And Prognosis Of Patients With Intraductal Papillary Mucinous Neoplasms Of The Pancreas

BackgroundPancreatic intraductal papillary mucinous neoplasm(IPMN)is a subtype of pancreatic cystic neoplasm(PCNs)which originates from pancreatic ductal epithelial cells and its prevalence is increased by age in the population.In the past,IPMN was a relatively rare pancreatic disease.However,with the improvement of imaging examination accuracy and popularization,the detection rate of IPMN has been greatly improved compared with the past.Although IPMN grows slowly,both subtypes of the main pancreatic duct type IPMN and the mixed type IPMN harbor a malignant potential.How to accurately diagnose and classify IPMN patients,the indications for surgical operation,as well as the frequency of surveillance,is still controversial.ObjectivesThrough a retrospective study of 48 IPMN cases diagnosed and treated in our hospital from 2013 to 2018,to explore diagnostic methods and surgical indications of IPMN,consequently providing advice for pancreatic surgeons.Materials and methodsPatients with IPMN who were managed surgically between March 2013 and September 2018 were retrospectively studied.Basic data were collected for each patient(including Age,gender,BMI,major symptoms,laboratory and imaging findings,surgical-related data,postoperative pathological findings.Survival prognosis was compared between symptomatic and asymptomatic patients.ResultsOf the 48 patients with IPMN,there were 30 males and 18 females with an average age of onset of 67.1 ±8.7 years.Among them,22 patients had no obvious clinical symptoms and another 26 patients showed different symptoms.Among all patients,10 patients had evaluated CA19-9,12 patients had higher CEA than normal,and up to 18 patients had higher fasting blood glucose.All patients underwent abdominal ultrasound and CT examination before operation,and 42 patients underwent MRI.According to the imaging results,28 patients were mainly MD-IPMN,18 were BD-IPMN,and 2 were MT=IPMN.All patients underwent surgical treatment after diagnosis.According to the location,28 patients underwent pancreaticoduodenectomy,another 18 underwent distal pancreatectomy,and only 2 underwent total pancreatectomy.All 48 patients with IPMN were followed up for a mean follow-up of 25.5±13.5 months.8 patients were dead and the rest were alive without recurrence.When compared with asymptomatic patients,symptomatic patients tend to have higher tumor markers and fasting blood glucose,larger tumor size,and higher postoperative recurrence rates.ConclusionsCompared with symptomatic IPMNs,asymptomatic IPMNs had a lower degree of malignancy and better prognosis.In the process of treating patients with IPMN,clinicians should comprehensively evaluate the classification of diseases and assess malignancy risk,through the clinical and radiological features.