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Progression Patterns in the Remnant Pancreas after Resection of Non-Invasive or Micro-Invasive Intraductal Papillary Mucinous Neoplasms (IPMN)

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although IPMN are thought to represent a whole-gland disease, segmental resection remains the most frequently performed treatment. We sought to determine the rates, patterns, and predictors of IPMN progression in the pancreatic remnant following segmental resection of noninvasive or microinvasive IPMN.

Methods

A prospectively maintained database was queried to identify all patients who underwent resection of noninvasive or microinvasive IPMN (≤ 10 mm of invasive component) between 1989 and 2015. Progression (recurrence) was defined as either the development of cancer, a new IPMN cystic lesion > 1 cm or ≥ 50% increase in the diameter of residual IPMN lesions in the remnant. Univariate and multivariate cox regression models were created to determine predictors of progression.

Results

A total of 319 patients underwent resection for noninvasive and microinvasive IPMN. The median age was 68, 53% had branch-duct (BD) IPMN, and 6% had microinvasive disease. After a median follow-up of 42 months, 71 patients (22%) experienced IPMN progression. Within this group of 71 patients, 11 (16% of recurrence) developed invasive cancer in the pancreatic remnant after a median of 28 months. Twelve patients (17%) experienced progression > 5 years following initial resection. On multivariate analysis, a distal location of the initial lesion was associated with an increased risk of progression (multivariate hazards ratio = 2.43, confidence interval 1.47–4.0, p < 0.001).

Conclusions

In this study, 22% of patients had disease progression following resection of noninvasive or microinvasive IPMN; 16% of these progressions represented invasive disease. These patients represent a high-risk group and should undergo long-term radiographic surveillance.

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Funding

Supported in part by Marshall and Therese Sonenshine Foundation

Author Contributions

Study conception and design: MAE, MAA, AAE, MG, MID, RPD, TPK, VB, WRJ, PJA. Acquisition of data: MAE, MAA. Analysis and interpretation of data: MAE, AAE, MG, PJA. Drafting of the manuscript: MAE, PJA. Critical revision: MAE, MAA, AAE, MG, OB, DK, MID, RPD, TPK, VB, WRJ, PJA.

Disclosure

Authors have nothing to disclose.

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Authors and Affiliations

  1. Department of Surgery, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Mohammad Al Efishat MD, Marc A. Attiyeh MD, Michael I. D’Angelica MD, FACS, Ronald P. DeMatteo MD, FACS, T. Peter Kingham MD, FACS, Vinod Balachandran MD, FACS, William R. Jarnagin MD, FACS & Peter J. Allen MD, FACS

  2. Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Anne A. Eaton MS & Mithat Gönen MD

  3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Olca Basturk MD & David Klimstra MD

Authors
  1. Mohammad Al Efishat MD
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  2. Marc A. Attiyeh MD
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  3. Anne A. Eaton MS
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  4. Mithat Gönen MD
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  5. Olca Basturk MD
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  6. David Klimstra MD
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  7. Michael I. D’Angelica MD, FACS
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  8. Ronald P. DeMatteo MD, FACS
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  9. T. Peter Kingham MD, FACS
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  10. Vinod Balachandran MD, FACS
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  11. William R. Jarnagin MD, FACS
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  12. Peter J. Allen MD, FACS
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Corresponding author

Correspondence to Peter J. Allen MD, FACS.

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Al Efishat, M., Attiyeh, M.A., Eaton, A.A. et al. Progression Patterns in the Remnant Pancreas after Resection of Non-Invasive or Micro-Invasive Intraductal Papillary Mucinous Neoplasms (IPMN). Ann Surg Oncol 25, 1752–1759 (2018). https://doi.org/10.1245/s10434-018-6445-2

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  • DOI: https://doi.org/10.1245/s10434-018-6445-2

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