Increased risk of second malignancy in pancreatic intraductal papillary mucinous tumors: Review of the literature

doi:10.3748/wjg.v21.i23.7313

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jun 21, 2015; 21(23): 7313-7319
Published online Jun 21, 2015. doi: 10.3748/wjg.v21.i23.7313

Increased risk of second malignancy in pancreatic intraductal papillary mucinous tumors: Review of the literature

Gian Luca Baiocchi, Sarah Molfino, Barbara Frittoli, Graziella Pigozzi, Federico Gheza, Giacomo Gaverini, Antonio Tarasconi, Chiara Ricci, Francesco Bertagna, Luigi Grazioli, Guido AM Tiberio, Nazario Portolani

Gian Luca Baiocchi, Sarah Molfino, Federico Gheza, Giacomo Gaverini, Antonio Tarasconi, Guido AM Tiberio, Nazario Portolani, Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, 25123 Brescia, Italy

Barbara Frittoli, Luigi Grazioli, 1^st Department of Radiology, Brescia Civil Hospital, 25123 Brescia, Italy

Graziella Pigozzi, Chiara Ricci, Department of Medical and Surgical Sciences, Gastroenterological Unit, University of Brescia, 25123 Brescia, Italy

Francesco Bertagna, Department of Surgical Specialties, Radiological and Forensic Sciences, Nuclear Medicine Section, University of Brescia, 25123 Brescia, Italy

Author contributions: All the Authors made substantial contributions to conception and design of the study, acquisition of data, or analysis and interpretation of data, drafted the article or made critical revisions related to important intellectual content of the manuscript, and finally approved the version of the article to be published. In particular, Baiocchi GL conceived the study and wrote the paper; Molfino S performed Literature search; Frittoli B, Pigozzi G, Gheza F, Gaverini G, Tarasconi A, Ricci C and Bertagna F analyzed the data provided by Molfino S; Grazioli L revised radiology-directed Literature; Tiberio GAM and Portolani N reviewed the paper.

Conflict-of-interest: No potential conflicts of interest relevant to this article were reported.

Data sharing: No additional data are available.

Correspondence to: Gian Luca Baiocchi, Professor, Department of Medical and Surgical Sciences, Surgical Clinic, University of Brescia, III Chirurgia, Spedali Civili di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy. gianluca.baiocchi@unibs.it

Telephone: +39-30-3995600 Fax: +39-30-3397476

Received: January 29, 2015
Peer-review started: January 29, 2015
First decision: March 10, 2015
Revised: April 12, 2015
Accepted: May 7, 2015
Article in press: May 7, 2015
Published online: June 21, 2015
Processing time: 142 Days and 2.3 Hours

Abstract

AIM: To analyze the available evidence about the risk of extrapancreatic malignancies and pancreatic ductal adenocarcinoma associated to pancreatic intraductal papillary mucinous tumors (IPMNs).

METHODS: A systematic search of literature was undertaken using MEDLINE, EMBASE, Cochrane and Web-of-Science libraries. No limitations for year of publication were considered; preference was given to English papers. All references in selected articles were further screened for additional publications. Both clinical series and Literature reviews were selected. For all eligible studies, a standard data extraction form was filled in and the following data were extracted: study design, number of patients, prevalence of pancreatic cancer and extrapancreatic malignancies in IPMN patients and control groups, if available.

RESULTS: A total of 805 abstracts were selected and read; 25 articles were considered pertinent and 17 were chosen for the present systematic review. Eleven monocentric series, 1 multicentric series, 1 case-control study, 1 population-based study and 3 case report were included. A total of 2881 patients were globally analyzed as study group, and the incidence of pancreatic cancer and/or extrapancreatic malignancies ranged from 5% to 52%, with a mean of 28.71%. When a control group was analyzed (6 papers), the same incidence was as low as 9.4%.

CONCLUSION: The available Literature is unanimous in claiming IPMNs to be strongly associated with pancreatic and extrapancreatic malignancies. The consequences in IPMNs management are herein discussed.

Keywords: Intraductal papillary mucinous neoplasm; Pancreas; Diagnosis; Follow-up; Tumors; Computed tomography scan; ¹⁸FDG-PET

Core tip: This paper enter a clinical debate which has real relevance in the daily practice in the field of pancreatic cystic neoplasm, as a number of asymptomatic intraductal papillary mucinous tumors (IPMNs) are diagnosed every day by abdominal imaging, and the actual most common clinical attitude provides for a weak diagnostic pathway. However, in the light of an unanimous literature, this attitude would be a while dangerous, as up to 30%-40% of IPMN cases would develop a second malignancy in their life. The same should be underlined when discussing the follow-up protocols.