Tatsuji Yogi1,2, Susumu Hijioka1, Hiroshi Imaoka1, Nobumasa Mizuno1, Kazuo Hara1, Masahiro Tajika3, Tsutomu Tanaka3, Makoto Ishihara3, Yasuhiro Shimizu4, Waki Hosoda5, Yasushi Yatabe5, Yasumasa Niwa3, Kenichi Yoshimura6, Vikram Bhatia7, Jiro Fujita2, Kenji Yamao1. 1. Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan. 2. Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases (First Department of Internal Medicine), Faculty of Medicine, University of the Ryukyus, Okinawa, Japan. 3. Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan. 4. Department of Gastrointestinal Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 5. Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan. 6. Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan. 7. Department of Hepatology, Institute of Liver and Biliary Sciences, Delhi, India.
Abstract
BACKGROUND: The aim of this study was to examine the associations between postoperative clinicopathological features of intraductal papillary mucinous neoplasm (IPMN) and recurrence over a long follow-up period. METHODS: We retrospectively assessed 153 IPMN patients who underwent resection. RESULTS: The resected tumors showed low/intermediate-grade dysplasia (LGD/IGD), high-grade dysplasia (HGD), T1a (stromal invasion ≤5 mm), and invasive intraductal papillary mucinous carcinoma (IPMC), in 54.9%, 22.2%, 4.6%, and 18.3% of patients, respectively. The median follow-up period after surgery was 46.4 (6.0-216.3) months, with an overall recurrence rate of 17.0%; the recurrence rates by histological type were 6.0%, 5.9%, 42.9%, and 57.1% for LGD/IGD, HGD, T1a, and invasive IPMC, respectively. Multivariate analysis revealed that recurrences related with tumor location, mural nodule size, presence of invasive cancer, lymph node metastasis, IPMN in the remnant pancreas, and main pancreatic duct dilatation after surgery. Recurrence occurred within the remnant pancreas in all LGD-T1a patients and as extrapancreatic metastasis in all patients with invasive IPMC. Of the total recurrences, 15.4% occurred over 5 years postoperatively. CONCLUSIONS: The postoperative follow-up protocol for patients with LGD-T1a should be similar to non-resected IPMN, and that for invasive IPMC should be the same as for pancreatic ductal adenocarcinoma patients.
BACKGROUND: The aim of this study was to examine the associations between postoperative clinicopathological features of intraductal papillary mucinous neoplasm (IPMN) and recurrence over a long follow-up period. METHODS: We retrospectively assessed 153 IPMN patients who underwent resection. RESULTS: The resected tumors showed low/intermediate-grade dysplasia (LGD/IGD), high-grade dysplasia (HGD), T1a (stromal invasion ≤5 mm), and invasive intraductal papillary mucinous carcinoma (IPMC), in 54.9%, 22.2%, 4.6%, and 18.3% of patients, respectively. The median follow-up period after surgery was 46.4 (6.0-216.3) months, with an overall recurrence rate of 17.0%; the recurrence rates by histological type were 6.0%, 5.9%, 42.9%, and 57.1% for LGD/IGD, HGD, T1a, and invasive IPMC, respectively. Multivariate analysis revealed that recurrences related with tumor location, mural nodule size, presence of invasive cancer, lymph node metastasis, IPMN in the remnant pancreas, and main pancreatic duct dilatation after surgery. Recurrence occurred within the remnant pancreas in all LGD-T1apatients and as extrapancreatic metastasis in all patients with invasive IPMC. Of the total recurrences, 15.4% occurred over 5 years postoperatively. CONCLUSIONS: The postoperative follow-up protocol for patients with LGD-T1a should be similar to non-resected IPMN, and that for invasive IPMC should be the same as for pancreatic ductal adenocarcinomapatients.
Authors: Mohammad Al Efishat; Marc A Attiyeh; Anne A Eaton; Mithat Gönen; Olca Basturk; David Klimstra; Michael I D'Angelica; Ronald P DeMatteo; T Peter Kingham; Vinod Balachandran; William R Jarnagin; Peter J Allen Journal: Ann Surg Oncol Date: 2018-03-27 Impact factor: 5.344