Recurrences After Surgical Resection of Intraductal Papillary Mucinous Neoplasm of the Pancreas

A Single-Center Study of Recurrence Predictive Factors

Abstract

Objective 

The detection of intraductal papillary mucinous neoplasms (IPMN) has increased over the last decade, but still, management remains controversial. The main problems are their potential for malignancy and risk of recurrence. The purpose of this study was to determine the predictive factors of recurrence after surgical resection.

Methods 

All patients with IPMN who underwent pancreatectomy with curative intent were considered. Data were collected from a prospective base.

Results 

From 1994 to 2009, 104 patients underwent pancreatectomy. Twenty-one (20%) had recurrence, 15 on remnant pancreas (none on pancreatic cut surface) and 6 with distant metastases. Twelve patients had total pancreatectomy (1 awaiting surgery). Thirteen (38.2%) of 34 patients with invasive IPMN and 20 (25.9%) of 77 with main duct involvement (including combined type) had recurrence. In univariate analysis, American Society of Anesthesiologist score and histological and duct type had a significant impact on recurrence rate. In multivariate analysis, histological type (invasiveness) was the only significant predictive factor for recurrence.

Conclusion 

The risk of recurrence of IPMN after resection depends on the histological type. According to surgical margin, invasiveness, and the type of duct involved, we identified a high-risk group with invasive main duct lesion and a low-risk group with noninvasive branch duct lesion.