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Multicenter Analysis of Clinicopathologic Features of Intraductal Papillary Mucinous Tumor of the Pancreas: Is It Possible to Predict the Malignancy Before Surgery?

¹ Department of Surgery, Seoul National University Hospital, 28 Yongon-dong, Changno-gu, 110-744, Seoul, Korea
² Department of Radiology, Seoul National University, Seoul 110-744, Korea
³ Department of Pathology, Seoul National University, Seoul 110-744, Korea
⁴ Department of Surgery, Ulsan University, Seoul 138-736, Korea
⁵ Department of Surgery, Sungkyunkwan University, Seoul 135-710, Korea
⁶ Department of Surgery, Chonbuk National University, Jeonju 561-712, Korea
⁷ Department of Surgery, Yonsei University, Seoul 120-752, Korea
⁸ Department of Surgery, Korea University, Seoul 136-701, Korea
⁹ Department of Surgery, Hanyang University, Seoul 133-792, Korea
¹⁰ Department of Surgery, Ajou University, Suwon 442-721, Korea
¹¹ Department of Surgery, Yeungnam University, Daegu 705-717, Korea
¹² Department of Surgery, Chonnam National University, Gwangju 501-757, Korea

Correspondence: Address correspondence and reprint requests to: Sun-Whe Kim, MD, FACS; E-mail: sunkim{at}plaza.snu.ac.kr.

Background: Despite recently increasing numbers of reports on intraductal papillary mucinous tumors (IPMTs), difficulties still remain in terms of diagnosis, treatment, and prognosis. The purpose of this multicenter study was to evaluate the clinicopathologic features of IPMT in Korea and to suggest predictive criteria for malignancy in IPMT.

Methods: We retrospectively reviewed the clinicopathologic data of 208 patients who underwent operations for IPMT between 1993 and 2002 at 28 institutes in Korea.

Results: Of the 208 patients (mean age, 61 years), 147 were men and 61 were women. A total of 124 patients underwent pancreatoduodenectomy, 42 underwent distal pancreatectomy, 17 underwent total pancreatectomy, and 25 underwent limited pancreatic resection. There were 128 benign cases (adenoma, n = 62; borderline, n = 66) and 80 malignant cases (noninvasive, n = 29; invasive, n= 51). A significant difference in 5-year survival was observed between the benign and malignant groups (92.6% vs. 65.3%; P = .006). Of the six factors (age, location, duct dilatation, mural nodule, main duct type, and tumor size) that showed statistical differences by univariate analysis between the benign and malignant groups, three were significant by multivariate analysis—namely, mural nodule (P = .009), tumor size (P = .023), and a dilated duct size (P = .010).

Conclusions: A significant proportion of IPMTs are malignant, although the overall prognosis of IPMT is superior to that of ordinary pancreatic cancer. Radical surgery is recommended for IPMT with the predictors of malignancy: mural nodule, tumor size (30 mm), and dilated duct size (12 mm).

Key Words: Intraductal papillary mucinous tumor • Multicenter study • Multivariate study • Malignancy prediction

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