Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):365-371. 10.14701/ahbps.2019.23.4.365.

Subtype of intraductal papillary mucinous neoplasm of the pancreas is important to the development of metachronous high-risk lesions after pancreatectomy

Affiliations
  • 1Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea. cardioman76@gmail.com
  • 2Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea.

Abstract

BACKGROUNDS/AIMS
Although intraductal papillary mucinous neoplasm (IPMN) has showed a favorable prognosis compared to pancreatic ductal adenocarcinoma, its recurrence patterns have somewhat questionable in detail. After partial pancreatectomy for IPMN, the evaluation for risk of metachronous occurrence of high-risk lesions (HRL) in the residual pancreas is important to establish a postoperative surveillance modality and duration of follow-up. This study aimed to evaluate the factors that may predict the metachronous occurrence of HRL in the remnant pancreas after surgery of the IPMN.
METHODS
From 2005 to 2016, clinicopathologic and surveillance data for 346 consecutive patients who underwent surgical resection for IPMN were reviewed retrospectively. Histologic subtype was classified as gastric, intestinal, pancreato-biliary, or oncocytic type.
RESULTS
All of IPMN were classified as main duct (n=64, 18.5%), branch duct (n=171, 49.4%), and mixed type (n=111, 32.1%). Forty-eight patients (13.9%) experienced recurrence during follow-up. Among these, 9 patients (2.6%) were identified to metachronous development of HRL in the remnant pancreas. After multivariate analysis, high-grade dysplasia (HGD) or invasive carcinoma (IC) compared to low- or intermediate dysplasia was only independent risk factor for recurrence (HR 3.688, 95% CI 2.124- 12.524, p=0.009). The independent risk factors for metachronous development were HGD/IC (HR 8.414, 95% CI 4.310- 16.426, p=0.001), and intestinal/pancreato-biliary subtype compared to gastric subtype (HR 7.874, 95% CI 3.650- 27.027, p=0.010).
CONCLUSIONS
Patients with high-grade dysplasia or invasive carcinoma, and with intestinal or pancreatobiliary subtype should undergo close, long-term surveillance of the remnant pancreas after initial resection.

Keyword

Intraductal papillary mucinous neoplasm; Pancreatectomy; Remnant pancreas; Subtype; Metachronous

MeSH Terms

Adenocarcinoma
Follow-Up Studies
Humans
Mucins*
Multivariate Analysis
Pancreas*
Pancreatectomy*
Pancreatic Ducts
Prognosis
Recurrence
Retrospective Studies
Risk Factors
Mucins

Figure

  • Fig. 1 Disease-free survival after pancreatectomy for IPMN. (A) DFS according to initial pathology. (B) DFS according to initial IPMN subtype. HGD, high-grade dysplasia; IGD, intermediate-grade dysplasia; LGD, low-grade dysplasia; IC, invasive carcinoma; 5Y DFS, 5-year disease-free survival; G, gastric subtype; I, intestinal subtype; PB, pancreato-biliary subtype.


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