Should non-invasive diffuse main-duct intraductal papillary mucinous neoplasms be treated with total pancreatectomy? |
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| Institution: | 1. Johns Hopkins Medical Institutions and the Pancreatic Cancer Precision Medicine Center of Excellence Program, Baltimore, MD, USA;2. Department of Surgery, Northwell Health, Manhasset, NY, USA;3. Department of Surgery, New York University, New York, NY, USA;1. Department of Surgery, Eulji University School of Medicine, 95, Dunsanseo-ro, Seo-gu, Daejeon, 35233, South Korea;2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea;3. Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea;1. Liver Transplant Surgery, Institute of Liver Studies, King''s College Hospital, London, SE5 9RS, United Kingdom;2. Hepatology, Department of Medicine, University of California, San Francisco, United States;3. Biostatistics, Department of Medicine and Preventive Medicine, University of Southern California, Los Angeles, United States;4. Hepatobiliary and Liver Transplant Surgery, St James''s University Hospital, Leeds, LS97TF, United Kingdom;5. Institute of Hepatology, Foundation for Liver Research, London, United Kingdom;6. Hepatology, Institute of Liver Studies, King''s College Hospital, London, United Kingdom;7. Liver Histopathology, Department of Histopathology, Institute of Liver Studies, King''s College Hospital, London, United Kingdom;8. Liver Transplant and HPB Surgery, Dr Rela Institute & Medical Center, Chennai, India;1. Western Clinical School, Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia;2. The University of Leeds, Leeds, UK;3. St. James''s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK;4. Institutul Clinic Fundeni - Centrul de Chirurgie Generala si Transplant Hepatic, Bucharest, Romania;5. Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK;6. Hospital Clinic Barcelona, Universitari Villarroel, Barcelona, Spain;7. Vall d''Hebron University Hospital, Barcelona, Spain;8. Klinik und Poliklinik für Chirurgie, München, Germany;9. Surgical Innovations Unit, Westmead Hospital, Sydney, Australia;1. Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, 75014, Paris, France;2. Department of Anesthesiology, Institut Mutualiste Montsouris, 75014, Paris, France;3. Department of Radiology, Institut Mutualiste Montsouris, 75014, Paris, France |
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| Abstract: | BackgroundMain-duct (MD) intraductal papillary mucinous neoplasm (IPMN) is associated with malignancy risk. There is a lack of consensus on treatment (partial or total pancreatectomy) when the MD is diffusely involved. We sought to characterize the pancreatic remnant fate after partial pancreatectomy for non-invasive diffuse MD-IPMN.MethodsConsecutive patients with partial pancreatectomy for non-invasive MD-IPMN from 2004 to 2016 were analyzed. Diffuse MD-IPMN was defined by preoperative imaging as dilation of the MD in the head of the pancreas more than 5 mm and involving the whole gland.ResultsOf 127 patients with resected non-invasive MD-IPMN, 47 (37%) had diffuse MD involvement. Eleven of 47(23%) patients developed imaging evidence of progression or new cystic disease in the pancreatic remnant. Patients with diffuse MD-IPMN were older (73yrs vs 67yrs, p = 0.009), more likely to receive a pancreaticoduodenectomy (96% vs 56%, p < 0.001) and have high-grade dysplasia (51% vs 31%, p = 0.025) than those with focal MD involvement. Diffuse MD involvement was not associated with shorter PFS following partial pancreatectomy (p = 0.613).ConclusionPartial pancreatectomy is an appropriate surgical approach for diffuse MD-IPMN, and is not associated with earlier progression after surgery as compared to partial pancreatectomy for focal dilation. |
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