Surgery and Survival

Surgical resection is the therapy of choice for both nonin-vasive and invasive IPMNs. Surgical strategies at present include the appropriate resection of the neoplasm with negative resection margins. In most patients this is followed by periodic postoperative surveillance for recurrent disease. For example, if an IPMN of the head of the gland is resected and the tail left in place, then the residual duct system can be followed with annual magnetic resonance cholangiopancreatography. Most patients with an IPMN are surgically resectable (between 80 and 98%). The 5-year survival rate for patients with surgically resected noninvasive IPMNs is > 90%, whereas the 5-year survival rate for patients with surgically resected IPMN with an associated invasive carcinoma is only 40%. The surgically resected patients with noninvasive IPMNs who recur presumably had multifocal disease in the pancreas because the 5-year survival rate for patients with noninvasive IPMNs who undergo total pancreatectomy approaches 100%.

The long history of symptoms experienced by most patients, the association of noninvasive IPMNs with an invasive cancer, and molecular genetic analyses of IPMNs, all suggest that noninvasive IPMNs can and do progress to invasive cancer over time. Although the time course or natural history of this progression is not known at present, the fact that some IPMNs do progress suggests an enormous opportunity to save lives that would otherwise be lost to invasive PC. If noninvasive IPMNs can be detected and surgically resected before an invasive cancer develops, then lives could be saved. The large size of most noninvasive IPMNs (3 cm in some series), suggests that it should be possible to detect these neoplasms using conventional imaging techniques such as endoscopic ultrasound (EUS) or computerized tomography. Indeed, we have recently reported an asymptomatic patient who was found to have a noninvasive IPMN by EUS. He underwent EUS because of a history that suggested he was at increased risk for developing a pancreatic neoplasm (see later section on familial PC). The IPMN was resected and this patient is presumably cured before a life threatening invasive cancer developed.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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