Frequency of extrapancreatic neoplasms in intraductal papillary mucinous neoplasm of the pancreas: Implications for management

OBJECTIVE: To estimate the frequency of extrapancreatic neoplasms in patients with IPMN compared with those with ductal pancreatic cancer and a general referral population. SUMMARY BACKGROUND DATA: Several studies have reported an increased risk of extrapancreatic neoplasms in patients with IPMN, but these studies focused only on those patients who underwent resection and excluded those patients treated nonoperatively. METHODS: All patients diagnosed with IPMN at Mayo Clinic from 1994 to 2006 were identified. Two control groups consisting of Group 1-patients with a diagnosis of ductal pancreatic adenocarcinoma (1:1) and Group 2-a general referral population (3:1) were matched for gender and age at diagnosis, year of registration, and residence. Logistic regression was used to assess the risk of a diagnosis of extrapancreatic neoplasms among cases versus controls. RESULTS: There were 471 cases, 471 patients in Group 1, and 1413 patients in Group 2. The proportion of IPMN patients having any extrapancreatic neoplasm diagnosed before or coincident to the index date was 52% (95% CI, 47%-56%), compared with 36% (95% CI, 32%-41%) in Group 1 (P < 0.001), and 43% (95% CI, 41%-46%) in Group 2 (P = 0.002). Benign neoplasms most frequent in the IPMN group were colonic polyps (n = 114) and Barrett's neoplasia (n = 18). The most common malignant neoplasms were nonmelanoma skin (n = 35), breast (n = 24), prostate (n = 24), colorectal cancers (n = 19), and carcinoid neoplasms (n = 6). CONCLUSIONS: Patients with IPMN have increased risk of harboring extrapancreatic neoplasms. Based on the frequency of colonic polyps, screening colonoscopy should be considered in all patients with IPMN.