Pancreatic resection for intraductal papillary mucinous neoplasm- a thirteen-year single center experience.
The purpose of this study is to review our results for pancreatic resection in patients with intraductal papillary mucinous neoplasm (IPMN) with and without associated carcinoma.



A total of 54 patients undergoing pancreatic resection for IPMN in a single university surgical center (Medical University of Graz) were reviewed retrospectively. Their survival rates were compared to those of patients with pancreatic ductal adenocarcinoma.



Twenty-four patients exhibit non-invasive IPMN and thirty patients invasive IPMN with associated carcinoma. The mean age is 67 (+/-11) years, 43 % female. Surgical strategies include classical or pylorus-preserving Whipple procedure (n = 30), distal (n = 13) or total pancreatectomy (n = 11), and additional portal venous resection in three patients (n = 3). Median intensive care stay is three days (range 1 - 87), median in hospital stay is 23 days (range 7 - 87). Thirty-day mortality is 3.7 %. Median follow up is 42 months (range 0 - 127). One-, five- and ten-year overall actuarial survival is 87 %; 84 % and 51 % respectively. Median overall survival is 120 months. Patients with non-invasive IPMN have significantly better survival than patients with invasive IPMN and IPMN-associated carcinoma (p < 0.008). In the subgroup of invasive IPMN with associated carcinoma, a positive nodal state, perineural invasion as well as lymphovascular infiltration are associated with poor outcome (p < 0.0001; <0.0001 and =0.001, respectively). Elevated CA 19-9(>37 U/l) as well as elevated lipase (>60 U/l) serum levels are associated with unfavorable outcome (p = 0.009 and 0.018; respectively). Patients operated for pancreatic ductal adenocarcinoma show significantly shorter long-term survival than patients with IPMN associated carcinoma (p = 0.001).



Long-term outcome after pancreatic resection for non-invasive IPMN is excellent. Outcome after resection for invasive IPMN with invasive carcinoma is significantly better than for pancreatic ductal adenocarcinoma. In low- and intermediate risk IPMN with no clear indication for immediate surgical resection, a watchful waiting strategy should be evaluated carefully against surgical treatment individually for each patient.
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
Katharina
K
Marsoner
Institute of Pathology, Medical University of Graz, Graz, Austria.
Johannes
J
Haybaeck
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
Dora
D
Csengeri
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
James Elvis
JE
Waha
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
Jakob
J
Schagerl
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
Rainer
R
Langeder
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
Hans Joerg
HJ
Mischinger
Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria. peter.kornprat@medunigraz.at.
Peter
P
Kornprat
D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
IPMN associated carcinoma; Invasive IPMN; Invasive intraductal papillary mucinous neoplasm (IPMN); Long-term survival; Non-invasive IPMN; Pancreatic resection; Perioperative outcome