Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm.
BACKGROUND
The risk of local recurrence in the pancreatic remnant after resection of noninvasive intraductal papillary mucinous neoplasm (IPMN) is not well defined.


METHODS
We performed a retrospective review of a prospectively maintained pancreatic resection database that identified 78 patients who underwent resection for noninvasive IPMN between 1983 and 2006. Local recurrence was determined radiographically and confirmed either pathologically or clinically.


RESULTS
At a median followup of 40 months, 6 patients (7.7%) have recurred locally, with a median interval of 22 months (range 8 to 62 months) from the time of resection. Three patients did not undergo additional operative treatment and died of disease progression. Three patients underwent additional resection and are alive without evidence of disease. The estimated 5-year local recurrence-free survival for all patients with noninvasive IPMN is 87%. One of 50 patients (2%) with margins negative for IPMN recurred versus 4 of 23 patients (17%) with margins positive for IPMN (p=0.02).


CONCLUSIONS
Patients who have undergone resection for noninvasive IPMN require indefinite surveillance because local recurrences may be identified several years from the initial operation and be resected while still noninvasive. Although the risk of local recurrence appears to increase in the setting of positive margins, the majority of patients with positive margins have not developed local recurrence. Negative margins should be the goal of the operation when achievable with partial pancreatectomy, but the risk of local recurrence is not high enough to mandate total pancreatectomy for microscopic positive margins.
White
Rebekah
R
Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
D'Angelica
Michael
M
Katabi
Nora
N
Tang
Laura
L
Klimstra
David
D
Fong
Yuman
Y
Brennan
Murray
M
Allen
Peter
P
D002288:Adenocarcinoma, Mucinous / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome