203 JOP. Journal of the Pancreas - http://pancreas.imedpub.com/ - Special Issue No. 2 – May 2017. [ISSN 1590-8577] ORIGINAL ARTICLE JOP. J Pancreas (Online) 2017 May 18; S(2):203-207. INTRADUCTAL PAPILLARY MUCINOUS NEOPLASM Intraductal Papillary Mucinous Neoplasms: The Bologna Experience Riccardo Casadei 1 , Carlo Alberto Pacilio 1 , Claudio Ricci 1 , Giovanni Taffurelli 1 , Nico Pagano 1 , Donatella Santini 2 , Marina Migliori 1 , Mariacristina Di Marco 2 , Carla Serra 1 , Lucia Calculli 2 , Roberto De Giorgio 1 , Francesco Minni 1 Department of 1 Medical and Surgical Sciences – DIMEC, S.Orsola and 2 Specialist, Diagnostic and Experimental Medicine (DIMES) - Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Italy ABSTRACT Background In the last decades, the attention to Intraductal Papillary Mucinous Neoplasms (IPMNs) has risen due to the increase of their incidental diagnosis. The aim of the present study was to evaluate which factors influenced survival in population affected by intraductal papillary mucinous neoplasms. Methods A retrospective study on a prospective database of 357 patients observed at our Institute from January 2007 to December 2016 was conducted. Pre-, intra- and postoperative data were collected. Patients managed conservatively were compared with those who underwent surgery as regards demographic, clinical data, radiological work up, features of the cysts and overall and disease specific survival. Multivariate analyses were carried out in order to assess factors related to patient’s management as well as those related to overall survival. Results Multivariate analysis showed that the factors strongly related to surgery were: site (tail of the pancreas-OR 4.48; P=0.011), presence of mural nodules (OR 15.39; P<0.001), Wirsung duct size >5 mm (OR 8.55; P<0.001), Wirsung duct size ≥ 10 mm (OR 133.75; P<0.001), positive citology (OR 19.81; P=0.008) and acute pancreatitis (OR 16.7; P<0.001); conversely, age was independently related to the follow up strategy (OR 0.93; P=0.001). Furthermore, parameters that significantly influenced overall survival were: age (HR 1.07; P<0.001), jaundice (HR 7.67; P<0.001) and the presence of mural nodules (HR 2.03; P=0.019). Conclusions Despite the limitations of the study, the main factors related to OS in our experience were age, jaundice and the presence of mural nodules within the cyst. Received March 06th, 2017-Accepted April 26th, 2017 Keywords Adenocarcinoma; Pancreas; Pancreatic Diseases Abbreviations BD branch duct; CEA carcinoembryogenic antigen; CT computed tomography scan; ERCP endoscopic retrograde cholangiopancreatography; EUS endoscopic ultrasound; FNA fine needle aspiration; HGD: high-grade dysplasia; IPMN intraductal papillary mucinous neoplasm; LGD low-grade dysplasia; MD main duct; MRI magnetic resonance imaging; PAC: pancreatic adenocarcinoma; PCN pancreatic cystic neoplasm; PD pancreatic duct Correspondence Riccardo Casadei Dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Chirurgia Generale-Minni Alma Mater Studiorum-Università di Bologna Policlinico S.Orsola-Malpighi Via Massarenti n.9 40138 Bologna, Italy Tel+ 39-051-341541 Fax +39-051-341483 E-mail riccardo.casadei@unibo.it INTRODUCTION The management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represents an important challenge in referral centres for pancreatic diseases [1, 2] expecially in the last years for the increase of their incidental diagnosis. The consensus conferences held, first, in Sendai in 2006 [3] and, secondly, in Fukuoka in 2010 [4], recognized risk factors to help surgeons and gastroenterologists in the choice of a proper management of the different types of IPMNs because they are considered a precursor lesion of pancreatic cancer via adenoma- carcinoma sequence [5]. Recent meta-analyses [6, 7, 8] and large cohort studies [9, 10, 11, 12] have provided informations regarding the accuracy of radiological features in IPMNs in order to detect in situ (high-grade dysplasia) or invasive carcinomas and to establish their proper management. The present study reports the experience of a tertiary referral centre regarding the management of IPMNs according Sendai and Fukuoka consensus conferences with the aim of evaluating the factors that influenced overall survival of patients who underwent to surgical approach compared to those who were followed-up. PATIENTS AND METHODS With the approval of the Ethic Committee of S.Orsola- Malpighi Hospital and patient informed consent, all patients with diagnosis of IPMN observed in our Department of Surgery from January 2007 to December 2016 were collected in a prospective database. Diagnostic work-up included abdominal ultrasonography (US), magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS) with or without fine needle aspiration and /or fine needle biopsy, serum CA 19-9 value and, in selected cases, multidetector computed tomography (MDCT). Cystic lesions not resected were classified as likely IPMNs if there were one or more pancreatic cysts >5 mm in diameter communicating with the main pancreatic duct (MPD) [3, 4] and divided in IPMN type I-II or III in relation to their morphological characteristics. According Fukuoka Consensus guidelines