title: Patterns of Recurrence After Resection of IPMN: Who, When, and How?
abstract: OBJECTIVE
  To describe the patterns of recurrence after resection of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.
  
  
  BACKGROUND
  IPMNs represent an increasing indication for pancreatic resection, but little is known about the actual incidence and the patterns of recurrence after surgical excision.
  
  
  METHODS
  Retrospective review of 412 resected IPMNs from 1990 to 2013 who have had near-complete follow-up.
  
  
  RESULTS
  Median age of the cohort was 68 years, 56% had branch duct (BD)-IPMN and 21% had invasive cancers. Nineteen patients (5%) had distinct pancreatic ductal adenocarcinoma (PDAC) and were excluded from the recurrence analysis. After a median of 58 months, 65 of 381 patients (17%) experienced recurrence of the IPMN, and 5- and 10-year disease-free survival (DFS) was 82% and 78%, respectively. Only 2 patients (0.5%) developed metachronous PDAC. In 33 patients (9%), a residual BD-IPMN was left in the pancreatic remnant, but none of these significantly grew or required reoperation. Invasive component and resection margin positive for IPMN were predictors of recurrence (P < 0.05). Invasive IPMN recurred in 45% of cases, whereas noninvasive in only 9% and later (P < 0.001), but patterns depended on IPMN subtypes. Only 9 patients required reoperation for recurrence, with good long-term outcome particularly for oncocytic IPMNs.
  
  
  CONCLUSIONS
  Recurrence of noninvasive BD-IPMN is infrequent and surveillance may be avoided in selected cases. In invasive IPMN recurrence depends on N status, pancreatic margin, and invasive type.
authors: *Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors: Giovanni
authors: G
authors: Marchegiani
authors: Mari
authors: M
authors: Mino-Kenudson
authors: Cristina R
authors: CR
authors: Ferrone
authors: Vicente
authors: V
authors: Morales-Oyarvide
authors: Andrew L
authors: AL
authors: Warshaw
authors: Keith D
authors: KD
authors: Lillemoe
authors: Carlos Fernández-Del
authors: CF
authors: Castillo
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*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome