Invasive intraductal papillary mucinous neoplasm: predictors of survival and role of adjuvant therapy.
BACKGROUND
Adjuvant treatment for pancreatic adenocarcinoma has been shown to improve survival. An increasingly recognized 'subtype' of pancreatic adenocarcinoma is invasive intraductal papillary mucinous neoplasm (IPMN). It is unclear whether adjuvant treatment for invasive IPMN improves survival. This study aimed to determine the impact of adjuvant treatment in invasive IPMN.


METHODS
We conducted a retrospective analysis of merged clinical databases including 412 patients undergoing resection for IPMN at two academic institutions between 1989 and 2006.


RESULTS
Of 412 patients with IPMN who underwent pancreatectomy, 98 had invasive carcinoma. Median survival in invasive IPMN was 32 months. Adjuvant treatment did not affect median survival in node-positive or node-negative invasive IPMN. Biopsy-proven recurrence of invasive IPMN occurred in 45 patients (46%). The median disease-free interval from resection to recurrence was 27 months. Treatment of recurrences with chemotherapy or radiation therapy was not associated with a difference in survival; however, a subgroup of patients with recurrence in the remnant pancreas who underwent re-resection appeared to have more favourable outcomes.


CONCLUSIONS
An invasive component measuring >2 cm and lymph node involvement are associated with poorer prognosis. Adjuvant therapy in invasive IPMN appears to confer no survival benefit. In selected patients with recurrence of invasive IPMN in the remnant pancreas, re-resection should be considered.
Turrini
Olivier
O
Department of Surgery, Indiana University, Indianapolis, IN, USA.
Waters
Joshua A
JA
Schnelldorfer
Thomas
T
Lillemoe
Keith D
KD
Yiannoutsos
Constantin T
CT
Farnell
Michael B
MB
Sarr
Michael G
MG
Schmidt
C Max
CM
D000368:Aged; D001706:Biopsy; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007196:Indiana; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008910:Minnesota; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D010180:Pancreatectomy / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
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