Troubles pancréatiques et thérapie
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Thérapie systémique adjuvante pour les IPMN de type intestinal invasif : une série de cas et une brève revue de la littérature

Brian E. Johnson*, Daniel S. Peiffer, Asha Dhanarajan, Ami Badami, Xianzhong Ding, Kenneth Micetich

Intraductal Papillary Mucinous Neoplasms (IPMNs) are epithelial neoplasms that can progress to invasive pancreatic malignancies. While the Sendai guidelines can assist us regarding which IPMNs are likely to be invasive and therefore need resection, there are limited data about management after resection. The adjuvant therapy for resected Invasive IPMNs (I-IPMNs) is currently based off of limited retrospective analyses and expert opinion extrapolating primarily from pancreatic exocrine regimens. The heterogeneity in both pathology and treatment response as seen in a recent systematic review suggests that we should consider delineating between the broad categories of intestinal/colloid type and pancreatobiliary/tubular type I-IPMNs to guide adjuvant systemic therapy similar to what is done with ampullary malignancies. Without prospective studies to guide our treatment decisions, we performed a literature review focused on the subgroup analyses of retrospective studies to modify and individualize the adjuvant systemic treatment of resected intestinal type I-IPMNs. Six months of adjuvant 5-fluorouracil based therapy appears to be a reasonable approach for fit, high-risk patients.