Predictors of Malignant Intraductal Papillary Mucinous Neoplasm of the Pancreas

Goals: The predictors of malignant intraductal papillary mucinous neoplasm (IPMN) and invasive IPMN were investigated in this study to determine the optimal indicators of surgical resection for IPMN. Background: Recently, international consensus guidelines have described the standard indicators of resection for IPMN. However, the indicators of surgical resection for IPMN, especially for branch duct IPMN, still remain controversial. Study: Eighty-two patients with IPMN who underwent surgical resection during April 1998 to January 2009, were retrospectively reviewed and examined with regard to their preoperative factors and pathologic diagnosis. Results: Multivariate analysis showed that main duct IPMN (P < 0.01) and earlier diabetes (P = 0.03) were independent predictors of malignant IPMN. In branch duct IPMN, the diameter of the main pancreatic duct (MPD) was found to be significantly associated with malignancy by univariate analysis (P = 0.034). An elevated serum CA19-9 level (P < 0.01) was an independent predictor of invasive IPMN. Conclusions: Our observations suggest that main duct IPMN, branch duct IPMN with MPD dilatation, and IPMN with an elevated serum CA19-9 level should be considered as indications for surgical resection. Key Words: intraductal papillary mucinous neoplasm, malignant IPMN, surgical indication