Prognostic Relevance of Subgroup Classification of Minimally Invasive Intraductal Papillary-Mucinous Carcinoma of the Pancreas
JY Kim, HJ Park, KT Jang. Samsung Medical Center, Seoul, Korea
Background: Intraductal papillary-mucinous neoplasm (IPMN) is a distinct entity of pancreas, which shows a good prognosis than conventional ductal adenocarcinoma. When IPMN accompanied invasive cancer, it is known that IPMN follows similar clinical course with ductal adenocarcinoma. However, the postoperative outcomes of invasive intraductal papillary-mucinous carcinoma (I-IPMC) showed various results. Recently non-aggresive subgroup classification of IPMC, as minimally invasive IPMC (MI-IPMC) was introduced.
Design: We reviewed surgically resected IPMN cases during 1996∼2008. We selected IPMC, and investigated the clinicopathological characteristics of fifty patients of IPMC. The cases were classified into 5 noninvasive IPMC and 45 I-IPMC on the basis of WHO classification. I-IPMC were divided further into 18 MI-IPMC and 27 invasive carcinomas originating in IPMC (IC-IPMCs) according to recently proposed subgroup classification criteria.
Results: When analyzed according to histologic subtype, 23 were intestinal type, 26 were pancreatobiliary type, and one was oncocytic type, respectively. Increased preoperative CA19-9 level was more frequently identified in IC-IPMCs (63%, 17/27) than in MI-IPMCs (16.7%, 3/18). Lymph node metastasis was noted in 9 patients, and all of them were IC-IPMC. The group of IC-IPMC showed more frequent recurrences such as lymph node or distant metastasis (72%) than MI-IPMC (0%) during follow up duration. There was no tumor recurrence or metastasis in patients of MI-IPMC, however 17 patients (62.9%) of IC-IPMC showed tumor recurrence and/or distant metastasis during follow.
Conclusions: The current results demonstrated the prognostic relevance of newly proposed subgroup classification of MI-IPMC, which should be differentiated from IC-IPMC. Thus, the recent subgroup classification of MI-IPMC seems to be a valid tool for prognostic analysis. If preoperative differentiation of MI-IPMC from IC-IPMC may be possible, it can be beneficial for avoiding unnecessary radical resection and additional LN dissection.
Category: Liver & Pancreas
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 200, Tuesday Afternoon