TY - JOUR
T1 - Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas
AU - Schnelldorfer, Thomas
AU - Sarr, Michael G.
AU - Nagorney, David M.
AU - Zhang, Lizhi
AU - Smyrk, Thomas C.
AU - Qin, Rui
AU - Chari, Suresh T.
AU - Farnell, Michael B.
PY - 2008/7
Y1 - 2008/7
N2 - Hypothesis: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN. Design: Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation. Setting: Mayo Clinic Rochester, a tertiary care center. Patients: All patients who underwent primary resection for pancreatic IPMN. Main Outcome Measures: Disease-specific operative outcomes, survival, and recurrence patterns. Results: Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Reresection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P=.26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy. Conclusions: Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.
AB - Hypothesis: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN. Design: Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation. Setting: Mayo Clinic Rochester, a tertiary care center. Patients: All patients who underwent primary resection for pancreatic IPMN. Main Outcome Measures: Disease-specific operative outcomes, survival, and recurrence patterns. Results: Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Reresection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P=.26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy. Conclusions: Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.
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U2 - 10.1001/archsurg.143.7.639
DO - 10.1001/archsurg.143.7.639
M3 - Review article
C2 - 18645105
AN - SCOPUS:47849105499
SN - 0004-0010
VL - 143
SP - 639
EP - 646
JO - Archives of Surgery
JF - Archives of Surgery
IS - 7
ER -