Surgical Management of Intraductal Papillary Mucinous Tumor of the Pancreas

ABSTRACT

BACKGROUND: Intraductal papillary mucinous tumor (IPMT) of the pancreas is a rare tumor arising in the main pancreatic duct or its subbranches. It is characterized by a diffusely or focally dilated main pancreatic duct filled with mucus and a mucus secretion through a patulous duodenal papilla. METHODS: The clinicopathologic characteristics of eight IPMT cases which were resected surgically from January 1994 to August 1998 at Seoul National University Hospital were reviewed to consider the optimal surgical treatment. RESULTS: The range of ages was from 49 to 70 years with a mean age of 59.3. Five were men and three were women. The prominent symptom was upper abdominal pain. Seven patients had been treated for pancreatitis before. Tumor markers didn't correlate with the pathologic status. In all the cases, a dilated pancreatic duct with secretion of mucin was found in the radiologic studies. Four lesions were located in the uncinate process, 3 in the body, and 1 diffusely. One total pancreatectomy, 1 Whipple's procedure, 3 pylorus-preserving pancreatoduodenectomies, 1 duodenum-preserving resection of the head of the pancreas, and 2 subtotal pancreatectomies were performed. Three lesions were malignant, another three were borderline malignant, and the remaining two were benign. Three were multiple lesions. Lesions for which the main pancreatic duct was dilated more than 0.5 cm, lesions greater than 2.5 cm, lesions with a mural nodule greater than 1.0 cm, or type 1, 2, 3 lesions were borderline malignant or malignant. There was no lymphatic metastasis. After a follow-up duration from 1 month to 56months, all patients are alive at the time of study and have experienced no locoregional recurrence or distant metastasis. CONCLUSIONS: In the radiologic studies, an IPMT should be considered in a multilobulating cystic lesion with the dilated main pancreatic duct. The lesions are variable from benign to malignant and often spread intraductally. When the lesion seems to be malignant, an aggressive resection is recommended.