Introduction
Until recently, all cystic tumours were treated surgically, including intraductal papillary mucinous neoplasms of the branch type (BD-IPMN). Currently, most patients with BD-IPMN are being followed up.
Aims & Methods
The aims of this study was to estimate the results of treatment of patients with IPMN.
A total of 228 patients with cystic pancreatic tumours who were treated at our department between 2012 and 2023 were included in the analysis. IPMN was diagnosed in 78 (34.2%) patients. All patients with IPMN were divided into two groups. The primary group included 56 patients who underwent surgery between 2018 and 2023 in accordance with the proposed algorithms. The comparison group comprised 22 patients who underwent surgery between 2012 and 2017. The two groups demonstrated comparable demographic characteristics, including age, gender distribution, and pathological structure.
In the diagnostic algorithm, we always perform MRI with the DWI and with magnetic resonance cholangiopancreatography. We also perform endoscopic ultrasound with fine-needle aspiration if required.
Until 2018, all types of IPMN were operated. Since 2018, we have revised our tactics. Indications for surgery were considered to be the presence of central and mixed type of IPMN or branch duct of IPMN with the presence of HRS and WF.
Of the 22 patients in the control group, central type IPMN was diagnosed in 10 patients (adenocarcinoma was diagnosed in 9, 1 patient was unresectable at the time of diagnosis), mixed type in 4 (2 patients had malignant tumours, 1 patient was unresectable at the time of diagnosis, 1 patient did not undergo surgery), and branch type in 8 (4 patients had malignant tumours, 2 patients - benign and in 2 patients we did not perform surgery). 17 patients with IPMN underwent surgery. Pancreatoduodenectomy (PDE) was performed in 9 patients, total pancreatectomy (TPE) in 1, distal pancreatectomy (DPE) in 7. Five patients were not operated: 2 patients had unresectable tumours diagnosed preoperatively, 2 patients with BD-IPMN were offered observation, 1 patient with mixed type IPMN refused surgery.
IPMN was diagnosed in 56 (40.6%) patients in the main group. Adenocarcinoma on the background of IPMN was diagnosed in 21 (37.5%) patients, all patients with central or mixed type of IPMN, of which PDE was performed in 12 patients, DPE with splenectomy in 8 patients, TPE - in 1 patient. IPMN with mild or severe dysplasia was diagnosed in 20 (35.7%) patients. Of these, PDE was performed in 13 patients, TPE in 1 patient and DPE in 6 patients. In 15 (26.8%) patients BD-IPMN without HGD and WF was diagnosed.
Results
In the comparison group, 17 (77.3%) patients underwent resection. Complications occurred in 6 (35.3%) patients, 3 of which were pancreatogenic complications (17.6%). In the main group, 41 (73.2%) patients underwent surgery. Complications occurred in 11 patients (26.8%). There was no mortality among these patients in either group. Of the 2 patients in the comparison group who were followed up, 1 patient had no progression of the disease, 1 patient was lost to follow-up, the outcome is unknown. Of the 15 patients in the main group with BD IPMN who were followed, none had disease progression.
Conclusion
The treatment of IPMN of the pancreas requires an individualized approach. In select patients, surveillance of presumed BD-IPMN can be safely discontinued. When choosing a wait-and-see approach in patients with BD-IPMN, it is imperative that the diagnosis not raise doubts.
