title: Management implications of resection margin histology in patients undergoing resection for IPMN: A meta-analysis.
abstract: BACKGROUND
  IPMN is a relatively new clinical entity and surgeons are continuing to develop their understanding of this complex pathology. Little is known of the natural disease process post-resection of an IPMN, particularly the impact of gland histology and margin status on the chance of recurrence and survival in benign and invasive IPMN.
  
  
  METHODS
  An online search was conducted to evaluate and include those studies which reported on gland histology, margin status and disease recurrence in resected benign and malignant IPMN. A Meta analysis was then performed using a random effects model.
  
  
  RESULTS
  The chance of recurrence in non-invasive margin positive IPMN is similar to margin negative IPMN. The chance of recurrence is higher in invasive gland IPMN compared to non-invasive gland. The vast majority of recurrences occurred in patients with positive margins demonstrating invasion.
  
  
  CONCLUSIONS
  All patients with intra- or post-operative evidence of invasive carcinoma at the resection margin should undergo further resection to achieve a negative margin. Patients with evidence of IPMN at the transaction margin (even with changes of high grade dysplasia/CIS) may not achieve any benefit from further resection. Patients with recurrence in benign/non-invasive IPMN should undergo re-resection, whereas patients with recurrence in invasive IPMN should not.
authors.affiliation: University Hospitals Leicester, Department of HPB Surgery, Leicester, LE5 4PW, UK. Electronic address: neilbhardwaj@yahoo.co.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Bhardwaj
authors.affiliation: University Hospitals Leicester, Department of HPB Surgery, Leicester, LE5 4PW, UK.
authors.forename: Ashley R
authors.initials: AR
authors.lastname: Dennison
authors.affiliation: University of Adelaide, Discipline of Surgery, The Queen Elizabeth Hospital, Woodville, Adelaide, Australia.
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Maddern
authors.affiliation: University Hospitals Leicester, Department of HPB Surgery, Leicester, LE5 4PW, UK.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Garcea
mesh_terms: D006801:Humans; D000072662:Margins of Excision; D015233:Models, Statistical; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
keywords: IPMN; Invasive IPMN; Pancreas; Pancreas recurrence; Pancreas resection; Pancreas resection margin