Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm

Abstract

Compared with patients undergoing complete operative IPMN clearance, patients with residual IPMN after segmental pancreatectomy do not demonstrate increased risk for the development of invasive disease or reduced survival. In patients without residual IPMN who later develop new IPMN, the risk for invasive IPMN is increased.

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

“…In these 5 studies, overall re-resection rates ranged from 3.1 to 8.5% and overall malignant recurrence rates ranged 339 from 1.6 to 5.6%, many of which were unresectable. This translated to generally favorable 5-year survival rates of 81-88% [2,3,31] . However, most studies had a median follow-up time of 3-5 years for what is known to be a slowly progressive disease, meaning the long-term risk is likely much higher.…”

“…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] . 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] .…”

“…Miller et al [31] took a slightly different approach to evaluating recurrence by investigating the impact of known residual disease in the pancreatic remnant. They divided 191 non-invasive IPMN into 2 groups based on the presence (remnant positive) or absence (remnant negative) of residual disease, which was defined as one or more unresected synchronous lesions and/or surgical margins positive for any grade of IPMN.…”

“…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).…”

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

“…Several follow‐up studies have revealed frequent development of remnant pancreatic lesions after resection of IPMN41, 45, 46, 47, 48, 49, 50 (Table 4). He et al46 reported that the 10‐year incidences of new IPMN, new IPMN requiring surgery, and invasive carcinoma in the remnant pancreas after resection of noninvasive IPMN were 62%, 18%, and 38%, respectively.…”