This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Branch duct intraductal papillary mucinous neoplasms in a retrospective series of 190 patients. BJS 2009; 96: 405-411.
Published: 12th March 2009
Authors: S. M. Woo, J. K. Ryu, S. H. Lee, W. J. Yoon, Y.‐T. Kim, Y. B. Yoon et al.
Background
A consensus conference has recommended close observation of branch duct intraductal papillary mucinous neoplasms (BD‐IPMNs) smaller than 30 mm, without symptoms or mural nodules. This study investigated whether these recommendations could be validated in a single‐centre experience of BD‐IPMNs.
Method
Some 190 patients with radiological imaging or histological findings consistent with BD‐IPMN were enrolled between 1998 and 2005. Those with less than 6 months' follow‐up and no histological confirmation were excluded.
Results
BD‐IPMN was diagnosed by computed tomography and pancreatography in 105 patients and pathologically in 85. Eighteen patients had adenoma, 53 borderline malignancy, five carcinoma in situ and nine invasive carcinoma. Findings associated with malignancy were the presence of radiologically suspicious features (P < 0·001) and a cyst size of at least 30 mm (P = 0·001). Had consensus guidelines been applied, 54 patients would have undergone pancreatic resection, whereas only 28 of these patients actually had a resection; 12 of the latter patients had a malignancy compared with none of the 26 patients who were treated conservatively.
Conclusion
A simple increase in cyst size is not a reliable predictor of malignancy. Observation is recommended for patients with a BD‐IPMN smaller than 30 mm showing no suspicious features on imaging. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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