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Surgical Delay Works for Many with Pancreatic Neoplasms

Italian study is one of few offering long-term results on substantial number of patients

TUESDAY, Aug. 7 (HealthDay News) -- Fewer than one in five patients with pancreatic branch-duct intraductal papillary mucinous neoplasms (BD-IPMN) should have surgery, according to a report in the August issue of Gut.

Claudio Bassi, M.D., of the University of Verona, Italy, and colleagues compared surgery versus conservative management in 109 patients with pancreatic BD-IPMN between 2000 and 2003. Patients with a malignancy and/or symptoms had surgery; asymptomatic patients underwent a clinical-radiological protocol.

The researchers found that 20 patients had surgery, which confirmed the diagnosis. In the other group, multifocal disease was seen in 57 of 89 patients within the 32-month follow-up. Five patients had surgery when lesions increased after a follow-up of 18.2 months. Of those, three had branch-duct adenoma and two had borderline adenoma.

"Surgery is indicated in fewer than 20 percent of cases of BD-IPMN, and, in the absence of malignancy-related parameters, careful non-operative management seems to be safe and effective in asymptomatic patients," the authors write.

In an editorial, John Neoptolemos, M.D., of the University of Liverpool in the U.K., and a colleague add that few studies offer long-term results on enough patients. "The strengths of this paper are that it is a prospective study with a large number of patients, the accuracy of the diagnosis was impressive… and complete follow-up data were available."

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