title: Prognostic impact of pancreatic margin status in the intraductal papillary mucinous neoplasms of the pancreas.
abstract: BACKGROUND
  Intraductal papillary mucinous neoplasm (IPMN) of the pancreas often recurs after operative resection. The absolute risk and incidence of recurrence, however, especially in the remnant pancreas, is unknown.
  
  
  METHODS
  We reviewed our 18-year experience of 144 surgical cases of IPMNs and selected 103 cases of benign IPMN and carcinoma in situ (CIS) for analysis of the clinicopathologic features and long-term outcome of the recurrent disease, with particular emphasis on the status of the cut margins of the pancreas.
  
  
  RESULTS
  No patient with benign IPMN died within 5 years. Recurrences in the remnant pancreas were observed in 9 cases: 4 (4.9%) among the 81 cases of benign IPMNs and 5 (22.7%) among the 22 cases of CIS. All recurrences were considered as multicentric because none recurred at the true resection margin of the previous operative resection. The pancreatic transection margin was normal or hyperplastic in 64 patients, whereas adenoma was detected at the margin in 28 patients. The presence of adenoma had no influence on the outcome, and recurrence in the remnant pancreas was diagnosed in 5 (7.8%) of 64 adenoma-negative patients and 3 (10.7%) of 28 adenoma-positive patients. Furthermore, both overall survival and recurrence-free survival were similar between the 2 groups.
  
  
  CONCLUSIONS
  In benign IPMN and CIS, a favorable prognosis can be expected irrespective of the status of the pancreatic cut surface, although follow-up with adequate imaging studies is recommended for detection and resection of the recurrent disease.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan. fjt@med.nagoya-u.ac.jp
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Koichi
authors.initials: K
authors.lastname: Kato
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Kanzaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Shin
authors.initials: S
authors.lastname: Takeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Shigeo
authors.initials: S
authors.lastname: Nakamura
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000473:pathology* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors