title: Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas.
abstract: OBJECTIVE
  Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN.
  
  
  METHODS
  Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation.
  
  
  METHODS
  Mayo Clinic Rochester, a tertiary care center.
  
  
  METHODS
  All patients who underwent primary resection for pancreatic IPMN.
  
  
  METHODS
  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. Re-resection 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.
authors.affiliation: Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schnelldorfer
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: Lizhi
authors.initials: L
authors.lastname: Zhang
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: Rui
authors.initials: R
authors.lastname: Qin
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis