INTRADUCTAL PAPILLARY AND MUCINOUS TUMORS OF THE PANCREAS - ACCURACY OF PREOPERATIVE COMPUTED-TOMOGRAPHY, ENDOSCOPIC RETROGRADE PANCREATOGRAPHY AND ENDOSCOPIC ULTRASONOGRAPHY, AND LONG-TERM OUTCOME IN A LARGE SURGICAL SERIES

Background: Few data are available on the accuracy of preoperative ima ging or on long-term outcome after surgery for intraductal papillary a nd mucinous tumors of the pancreas. The aims of this study were to ass ess the following: (1) the accuracy of preoperative computed tomograph y, endoscopic retrograde pancreatography, and endoscopic ultrasonograp hy for determination of tumor invasion and pancreatic extension as com pared with surgical findings; (2) the long-term outcome after surgery. Methods: Forty-seven patients who underwent surgery between 1980 and 1995 for pathologically diagnosed intraductal papillary and mucinous t umors were included in this study. The findings of available computed tomography (n = 25), endoscopic retrograde pancreatography (n = 29), a nd endoscopic ultrasonography (n = 21) were reviewed by experienced cl inicians blinded to pathologic diagnosis to assess tumor invasion and pancreatic extension. Pathologic specimens were reviewed by experience d pathologists. Postoperative follow-up data were analyzed. Results: H istologic features of invasive carcinoma were found in 43% of patients , severe dysplasia in 21%, and mild or moderate dysplasia in 36%. The overall accuracy of computed tomography, endoscopic retrograde pancrea tography, and endoscopic ultrasonography in distinguishing between inv asive and noninvasive tumors were, respectively, 76%, 79%, and 76%. Th e overall 3-year disease-free survival rate was 63%, but it was 21% am ong patients with invasive carcinoma at surgery (p < 0.001). Conclusio ns: This study emphasizes the need for early surgical resection in pat ients with suspected intraductal papillary and mucinous tumors of the pancreas because of the high frequency of invasive carcinoma and the i nadequacy of preoperative imaging for assessing malignancy.