Progression patterns in the remnant pancreas after resection of non-invasive or micro-invasive intraductal papillary mucinous neoplasms (IPMN) Journal Article

Authors: Al Efishat, M.; Attiyeh, M. A.; Eaton, A. A.; Gönen, M.; Basturk, O.; Klimstra, D.; D’Angelica, M. I.; DeMatteo, R. P.; Kingham, T. P.; Balachandran, V.; Jarnagin, W. R.; Allen, P. J.
Article Title: Progression patterns in the remnant pancreas after resection of non-invasive or micro-invasive intraductal papillary mucinous neoplasms (IPMN)
Abstract: Background: Although IPMN are thought to represent a whole-gland disease, segmental resection remains the most frequently performed treatment. We sought to determine the rates, patterns, and predictors of IPMN progression in the pancreatic remnant following segmental resection of noninvasive or microinvasive IPMN. Methods: A prospectively maintained database was queried to identify all patients who underwent resection of noninvasive or microinvasive IPMN (≤ 10 mm of invasive component) between 1989 and 2015. Progression (recurrence) was defined as either the development of cancer, a new IPMN cystic lesion > 1 cm or ≥ 50% increase in the diameter of residual IPMN lesions in the remnant. Univariate and multivariate cox regression models were created to determine predictors of progression. Results: A total of 319 patients underwent resection for noninvasive and microinvasive IPMN. The median age was 68, 53% had branch-duct (BD) IPMN, and 6% had microinvasive disease. After a median follow-up of 42 months, 71 patients (22%) experienced IPMN progression. Within this group of 71 patients, 11 (16% of recurrence) developed invasive cancer in the pancreatic remnant after a median of 28 months. Twelve patients (17%) experienced progression > 5 years following initial resection. On multivariate analysis, a distal location of the initial lesion was associated with an increased risk of progression (multivariate hazards ratio = 2.43, confidence interval 1.47–4.0, p < 0.001). Conclusions: In this study, 22% of patients had disease progression following resection of noninvasive or microinvasive IPMN; 16% of these progressions represented invasive disease. These patients represent a high-risk group and should undergo long-term radiographic surveillance. © 2018, Society of Surgical Oncology.
Keywords: cancer survival; aged; major clinical study; overall survival; cancer recurrence; cancer growth; tumor localization; metastasis; tumor volume; ca 19-9 antigen; carcinoembryonic antigen; intraductal papillary mucinous tumor; risk factor; new york; tumor invasion; human; male; female; article; segmentectomy
Journal Title: Annals of Surgical Oncology
Volume: 25
Issue: 6
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2018-06-01
Start Page: 1752
End Page: 1759
Language: English
DOI: 10.1245/s10434-018-6445-2
PROVIDER: scopus
PUBMED: 29589164
Notes: Article -- Export Date: 1 June 2018 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    597 DeMatteo
  2. Mithat Gonen
    701 Gonen
  3. Olca Basturk
    203 Basturk
  4. David S Klimstra
    843 Klimstra
  5. Peter Allen
    436 Allen
  6. William R Jarnagin
    583 Jarnagin
  7. T Peter Kingham
    281 Kingham
  8. Anne Austin Eaton
    115 Eaton
  9. Marc   Attiyeh
    21 Attiyeh