Impact of pancreatic margin status and lymph node metastases on recurrence after resection for invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis.
BACKGROUND
Accurate information is currently lacking regarding the values of positive margins (M(+)) and lymph node (LN) metastases as independent predictors of postoperative recurrence in invasive and noninvasive intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.


METHODS
A comprehensive online literature search identified all types of primary studies that included M(+) and LN metastases as risk factors and deﬁned recurrence as an outcome in patients with IPMNs. Suitable articles were also identified by manually researching references in qualifying articles. A meta-analysis of the result was performed using a random effects model.


RESULTS
The recurrence rate in noninvasive IPMNs was 3.72% in patients with negative margin (M(-)) versus 9.56% in those with M(+) (odds ratio, OR = 0.37, 95% conﬁdence interval, 95% CI: 0.17-0.78, p = 0.010). The recurrence rate in invasive M(-) IPMNs in was 33.85% compared to 53.66% in M(+) IPMNs (OR = 0.47, 95% CI: 0.25-0.88, p = 0.020). The recurrence rate in invasive IPMNs with positive LN was 76.92% compared to 30.86% with negative LN; OR = 0.15, 95% CI: 0.06-0.37, p < 0.0001).


CONCLUSIONS
M(+) were associated with disease recurrence in all patients with IPMN, and nodal metastases were significantly associated with recurrence in invasive IPMN.
Department of Hepatopancreatobiliary Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Kai-Ming
KM
Leng
Zhi-Dong
ZD
Wang
Jing-Bo
JB
Zhao
Yun-Fu
YF
Cui
Xiang-Yu
XY
Zhong
D002288:Adenocarcinoma, Mucinous / Q000556:secondary* / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000556:secondary* / Q000601:surgery; D002291:Carcinoma, Papillary / Q000556:secondary* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018365:Neoplasm, Residual; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery*