Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas

Background: The surgical strategy in patients with a pancreatic intraductal papillary mucinous tumour (IPMT) is still controversial. In this study the pathological findings in a series of patients were used to rationalize sur gical choice. Methods: Fifty-one patients with IPMT were observed between 1988 and 1998 a nd treated by pancreatic resection. Factors evaluated included symptoms, tu mour site, type of operation, histological findings and resection margins, tumour stage, follow-up and survival. Results: Pancreaticoduodenectomy was the most frequent surgical treatment ( 33 patients; 65 per cent), followed by left pancreatectomy (ten), total pan createctomy (five) and middle pancreatectomy (three). Histological assessme nt revealed the tumour to be an adenoma in 13 patients (25 per cent), a bor derline tumour in ten (20 per cent) and a carcinoma in 28 (55 per cent), 19 of which were invasive. Mild to moderate dysplasia was present at the rese ction margin in 20 specimens (41 per cent), and carcinoma in one. Local rec urrence was observed in four patients (8 per cent), all of whom underwent a second resection. The 3-year actuarial survival rate for benign and malign ant disease was 94 and 69 per cent respectively (P = 0.03). Conclusion: These results suggest that resection should be the treatment fo r IPMT. Management of the resection margin could be crucial in avoiding tum our recurrence.