췌관 내 유두상 점액성 종양의 외과적 치료
Surgical Treatment for Intraductal Papillary Mucinous Tumor of the Pancreas
장원영, 허진석, 노재형, 손태성, 최성호, 김용일,
소속 상세정보
장원영 ( Chang Weon-Young )
성균관대학교 의과대학 외과학교실
허진석 ( Heo Jin-Seok )
성균관대학교 의과대학 외과학교실
노재형 ( Noh Jae-Hyung )
성균관대학교 의과대학 외과학교실
손태성 ( Sohn Tae-Sung )
성균관대학교 의과대학 외과학교실
최성호 ( Choi Seong-Ho )
성균관대학교 의과대학 외과학교실
김용일 ( Kim Yong-Il )
성균관대학교 의과대학 외과학교실
KMID : 0371320020620060491
Abstract
Purpose: The surgical strategy for patients with a pancreatic intraductal papillary mucinous tumor (IPMT) is still controversial. In this study the clinicopathologic findings in a series of patients were used to rationalize surgical choice
and
reassess the need for a total pancreatectomy.
Methods: Between Oct. 1994 and Nov. 2001, 25 patients with IPMT underwent surgery. We retrospectively examined the clinicopathologic features and surgical treatment. The factors evaluated included: symptoms, tumor site, operation type,
histological findings, resection margin, follow-up and survival.
Results: Pancreaticoduodenectomy was the most frequent surgical treatment (10 patients: 40%) followed by distal pancreatectomy (6), pylorus-preserving-pancreatico-duodenectomy (5) and total pancreatectomy (4). Histological assessment
revealed the
tumors to be an adenoma in 11 patients (44%), a borderline tumor in 8 patients (32%) and a carcinoma in 6 patients (24%). There were no operative or hospital deaths. All of the cases with hyperplasia, adenoma and noninvasive carcinoma survived.
Only two
of the patients with invasive carcinoma died. Mild to moderate dysplasia was present at the resection margin in two patients (8%), and carcinoma in one. A total pancreatectomy was performed in four patients. Invasive carcinoma patient survival
was
significantly associated with the presence of peri- pancreatic lymph node involvement.
Conclusions: Our study and review of the literature indicates that preoperative indicators of malignancy in IPMT are still lacking. These results suggest that resection should be the treatment for IPMT. Sometimes IPMT is best treated by a
total
pancreatectomy, although lesser subtotal resections should definitely be considered. When selecting a surgical procedure for treating these tumors, it is useful to confirm the tumors’ extent by intra-operative imaging modalities. In the cases
with
invasion, a radical resection is required.
키워드
췌장; 췌관 내 유두상 점액성 종양; 췌 전 절제술; Pancreas; Intraductal papillary mucinous tumor (IPMT); Total pancreatectomy;
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