Long-term Prospective Cohort Study of Patients Undergoing Pancreatectomy for Intraductal Papillary Mucinous Neoplasm of the Pancreas

Abstract

Pancreatic IPMNs recur in 10.7% of patients. Recurrence is correlated with the degree of dysplasia, and 5.4% of patients with benign or noninvasive IPMN have recurrences including distant metastasis. Thorough postoperative surveillance is needed not only for patients with invasive IPMN but also for those with benign or noninvasive IPMN, especially for patients with high-grade dysplasia.

Comparison of guidelines for intraductal papillary mucinous neoplasm: What is the next step beyond the current guidelines?

“…Therefore, it is reasonable to carry out postoperative surveillance for invasive IPMN as done for PDAC. Besides recurrence of invasive IPMN, several investigators have reported recurrent lesions after resection of noninvasive IPMN 39, 40, 41, 42, 43, 44. We also experienced peritoneal dissemination after resection of high‐grade IPMN 7.…”

Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

“…Another study observed that 10.3% of highgrade IPMN recurred as cancer compared to 0.6% among low and intermediate-grade lesions [31] . High-grade dysplasia also resulted in lower rates of overall 5-year survival ranging from 72 to 83% compared to 85-90% for those with low and intermediate grade dysplasia [3,35] . Similar to positive margin status, the presence of high-grade dysplasia may serve as an indicator of more diffuse involvement or advanced progression of disease and indicate the potential for unrecognized foci of high-grade dysplasia in other regions of the pancreas as well [35] .…”

“…Furthermore, the different histological subtypes of IPMN tend to recur at different rates. Among non-invasive IPMN, reported recurrence rates are 3.4, 9.8, 11.1 and 0% for gastric, intestinal, pancreatobiliary and oncocytic types, respectively [35] . Preoperative identification of pancreatobiliary or intestinal type would be beneficial for risk stratification and planning the type and extent of resection best suited for a patient.…”

“…High-Grade Dysplasia Some studies have identified an association between recurrence and the presence of high-grade dysplasia in the initially resected IPMN [3,31,35] . In one study, recurrence was significantly higher following resection of highgrade versus low-and intermediate-grade IPMN (13.3 vs. 4.0%; p = 0.027).…”

“…In one study, recurrence was significantly higher following resection of highgrade versus low-and intermediate-grade IPMN (13.3 vs. 4.0%; p = 0.027). The authors went on to identify this on multivariable analysis the single most important predictor of recurrence with an OR of 3.9 (95% CI 1.3-11.9; p = 0.018) [35] . Another study observed that 10.3% of highgrade IPMN recurred as cancer compared to 0.6% among low and intermediate-grade lesions [31] .…”