Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts

Am J Surg. 2009 Nov;198(5):709-14. doi: 10.1016/j.amjsurg.2008.10.022.


Introduction: The appropriate management of patients with branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) with multiple involvements of branch ducts (multifocal BD-IPMN) remains challenging.

Patients and methods: Our database of patients affected by IPMN was queried to identify patients with a clinicoradiologic or a pathologic diagnosis of multifocal BD-IPMN between January 1990 and December 2006.

Results: One hundred thirty-one patients (52 male and 79 female; median age 67 years) had a clinicoradiologic or a histopathologic diagnosis of multifocal BD-IPMN. Ten patients (7.6%) underwent surgery. After a median follow-up of 40 months (range 12 to 127) all the 121 patients conservatively managed are alive, and none underwent surgery during follow-up. One patient with invasive carcinoma developed hepatic metastases and died of disease 88 months after surgery.

Comments: Patients with branch-side IPMN can be conservatively managed, but when multifocality is present follow-up may be problematic because of the number of lesions to be evaluated. The nonoperative management of well-selected patients with BD-IPMN, even in the multifocal setting, seems to be safe and reliable.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma, Mucinous / diagnostic imaging
  • Adenocarcinoma, Mucinous / pathology*
  • Adenocarcinoma, Mucinous / surgery*
  • Aged
  • Aged, 80 and over
  • Carcinoma in Situ / pathology
  • Carcinoma in Situ / surgery
  • Carcinoma, Pancreatic Ductal / diagnostic imaging
  • Carcinoma, Pancreatic Ductal / pathology
  • Carcinoma, Pancreatic Ductal / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreatectomy
  • Pancreatic Ducts / pathology*
  • Pancreatic Neoplasms / diagnostic imaging
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / surgery*
  • Radiography