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Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation.

Publication ,  Journal Article
Lafemina, J; Katabi, N; Klimstra, D; Correa-Gallego, C; Gaujoux, S; Kingham, TP; Dematteo, RP; Fong, Y; D'Angelica, MI; Jarnagin, WR; Do, RK ...
Published in: Ann Surg Oncol
February 2013

BACKGROUND: Intraductal papillary mucinous neoplasms (IPMN) may represent a field defect of pancreatic ductal instability. The relative risk of carcinoma in regions remote from the radiographically identified cyst remains poorly defined. This study describes the natural history of IPMN in patients initially selected for resection or surveillance. METHODS: Patients with IPMN submitted to resection or radiographic surveillance were identified from a prospectively maintained database. Comparisons were made between these two groups. RESULTS: From 1995 to 2010, a total of 356 of 1,425 patients evaluated for pancreatic cysts fulfilled inclusion criteria. Median follow-up for the entire cohort was 36 months. Initial resection was selected for 186 patients (52 %); 114 had noninvasive lesions and 72 had invasive disease. A total of 170 patients underwent initial nonoperative management. Median follow-up for this surveillance group was 40 months. Ninety-seven patients (57 % of those under surveillance) ultimately underwent resection, with noninvasive disease in 79 patients and invasive disease in 18. Five of the 18 (28 %) invasive lesions developed in a region remote from the monitored lesion. Ninety invasive carcinomas were identified in the entire population (25 %), ten of which developed the invasive lesion separate from the index cyst, representing 11 % with invasive disease. CONCLUSIONS: Invasive disease was identified in 39 % of patients with IPMN selected for initial resection and 11 % of patients selected for initial surveillance. Ten patients developed carcinoma in a region separate from the radiographically identified IPMN, representing 2.8 % of the study population. Diagnostic, operative, and surveillance strategies for IPMN should consider risk not only to the index cyst but also to the entire gland.

Duke Scholars

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

February 2013

Volume

20

Issue

2

Start / End Page

440 / 447

Location

United States

Related Subject Headings

  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Invasiveness
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Lafemina, J., Katabi, N., Klimstra, D., Correa-Gallego, C., Gaujoux, S., Kingham, T. P., … Allen, P. J. (2013). Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol, 20(2), 440–447. https://doi.org/10.1245/s10434-012-2702-y
Lafemina, J., N. Katabi, D. Klimstra, C. Correa-Gallego, S. Gaujoux, T. P. Kingham, R. P. Dematteo, et al. “Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation.Ann Surg Oncol 20, no. 2 (February 2013): 440–47. https://doi.org/10.1245/s10434-012-2702-y.
Lafemina J, Katabi N, Klimstra D, Correa-Gallego C, Gaujoux S, Kingham TP, et al. Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol. 2013 Feb;20(2):440–7.
Lafemina, J., et al. “Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation.Ann Surg Oncol, vol. 20, no. 2, Feb. 2013, pp. 440–47. Pubmed, doi:10.1245/s10434-012-2702-y.
Lafemina J, Katabi N, Klimstra D, Correa-Gallego C, Gaujoux S, Kingham TP, Dematteo RP, Fong Y, D’Angelica MI, Jarnagin WR, Do RK, Brennan MF, Allen PJ. Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol. 2013 Feb;20(2):440–447.
Journal cover image

Published In

Ann Surg Oncol

DOI

EISSN

1534-4681

Publication Date

February 2013

Volume

20

Issue

2

Start / End Page

440 / 447

Location

United States

Related Subject Headings

  • Survival Rate
  • Prospective Studies
  • Prognosis
  • Pancreatic Neoplasms
  • Pancreatectomy
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Neoplasm Invasiveness
  • Middle Aged
  • Male