Risk of misdiagnosis and overtreatment in patients with main pancreatic duct dilatation and suspected combined/main-duct intraductal papillary mucinous neoplasms

• Published in: Surgery 2016-04, Vol.159 (4), p.1041-1049
• Main Authors: Crippa, Stefano, MD, PhD, Pergolini, Ilaria, MD, Rubini, Corrado, MD, Castelli, Paola, Partelli, Stefano, MD, PhD, Zardini, Claudio, MD, Marchesini, Giorgia, MD, Zamboni, Giuseppe, MD, Falconi, Massimo, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Pancreatic Ductal - diagnosis; Carcinoma, Pancreatic Ductal - surgery; Diagnosis, Differential; Diagnostic Errors - statistics & numerical data; Dilatation, Pathologic; Female; Humans; Male; Medical Overuse - statistics & numerical data; Middle Aged; Pancreatectomy - methods; Pancreatic Ducts - pathology; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - surgery; Pancreatitis, Chronic - diagnosis; Retrospective Studies; Surgery
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2015.11.003

Background Segmental/diffuse dilatation of the main pancreatic duct (MPD) is the typical feature of combined/main-duct intraductal papillary mucinous neoplasms (CMD-IPMNs). MPD dilation in IPMNs may be also expression of mucus hypersecretion/obstructive chronic pancreatitis (OCP). The aim of this study was to evaluate the presence and extension of MPD involvement by tumor/OCP and assess the risk of overtreatment. Methods Retrospective analysis of suspected CMD-IPMNs resected between January 2009 and October 2014 were included. Pathologic correlations among MPD dilatation, IPMN, and OCP was searched. Results Overall, 93 patients were resected for suspected CMD-IPMNs. At pathology, CMD-IPMNs were found in 69 patients (74%). Branch-duct IPMNs (BD-IPMNs) were found in 8 cases (9%), pancreatic ductal adenocarcinoma (PDAC) in absence of IPMN in 9 (10%), cystic neuroendocrine tumor (NET G2) in 1 (1%), serous cystadenoma in 2 (2%), and OCP alone/mucinous metaplasia in 4 patients (4%). Overall, 18 patients (19%) underwent an overtreatment because unnecessary (2 BD-IPMNs, 2 serous cystadenomas, and 4 OCPs only) or too extensive resections (9 CMD-IPMNs and 1 PDAC with associated OCP). In these, total pancreatectomy was the most common procedure (67%). Median size of MPD in IPMN-involved area was 12 mm compared with 7 mm when only OCP was found ( P