title: Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: a retrospective review.
abstract: OBJECTIVE
  To clarify the recurrence pattern after resection of main duct intraductal papillary mucinous neoplasms (MD-IPMNs) using molecular analyses and determine the most adequate treatment strategy.
  
  
  BACKGROUND
  The most appropriate resection line for MD-IPMNs remains an unresolved issue.
  
  
  METHODS
  Medical records of 56 patients with pancreatectomy were retrospectively reviewed. Histological subtypes and Kras/GNAS mutations were assessed in patients with recurrence in the remnant pancreas.
  
  
  RESULTS
  Forty-nine patients underwent partial pancreatectomy and 7 underwent total pancreatectomy. Thirty-six patients (64%) had malignant MD-IPMNs. Recurrence was observed in 7 of 49 patients (14%), including 6 with malignant IPMNs and 1 with pancreatic ductal adenocarcinoma, all of whom underwent remnant pancreatectomy. The cumulative disease-specific survival rate of patients with pancreatic recurrence was greater than that of patients with extrapancreatic recurrence (P < 0.001). Although the pancreatic margin status at the initial operation did not affect the pancreatic recurrence rate, all 4 recurrent IPMNs examined had histological subtypes and Kras/GNAS mutations identical to those of the initial lesions. Four patients experienced recurrence in the remnant pancreas or systemic recurrence after resection of high-grade dysplasia of MD-IPMN. Three of the 56 patients had concomitant pancreatic ductal adenocarcinomas and MD-IPMNs.
  
  
  CONCLUSIONS
  One-step total pancreatectomy can be avoided, and remnant total pancreatectomy would lead to favorable outcomes even in patients with pancreatic recurrence, some cases of which seem to involve residual lesions. Postoperative surveillance of high-grade dysplasia should be performed as if malignant, and close attention should be paid to the occurrence of concomitant pancreatic ductal adenocarcinomas in patients with MD-IPMNs.
authors.affiliation: Departments of *Surgery and Oncology †Anatomic Pathology ‡Clinical Radiology, and §Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tamura
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Teppei
authors.initials: T
authors.lastname: Aso
authors.forename: Koji
authors.initials: K
authors.lastname: Shindo
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.forename: Kenoki
authors.initials: K
authors.lastname: Ohuchida
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ushijima
authors.forename: Tetsuhide
authors.initials: T
authors.lastname: Ito
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mizumoto
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002864:Chromogranins; D005260:Female; D005500:Follow-Up Studies; D019205:GTP-Binding Protein alpha Subunits, Gs / Q000235:genetics; D005819:Genetic Markers; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017354:Point Mutation; D011518:Proto-Oncogene Proteins / Q000235:genetics; D016283:Proto-Oncogene Proteins p21(ras); D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D018631:ras Proteins / Q000235:genetics
chemical_list: D002864:Chromogranins; D005819:Genetic Markers; C117307:KRAS protein, human; D011518:Proto-Oncogene Proteins; C406732:GNAS protein, human; D019205:GTP-Binding Protein alpha Subunits, Gs; D016283:Proto-Oncogene Proteins p21(ras); D018631:ras Proteins