Seiko Hirono1, Manabu Kawai1, Ken-Ichi Okada1, Motoki Miyazawa1, Atsushi Shimizu1, Yuji Kitahata1, Masaki Ueno1, Akio Yanagisawa2, Hiroki Yamaue3. 1. Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan. 2. Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 3. Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan. Electronic address: yamaue-h@wakayama-med.ac.jp.
Abstract
BACKGROUND: There is not enough evidence to establish an appropriate surveillance strategy after operative resection for intraductal papillary mucinous neoplasm. METHODS: This study included 257 consecutive intraductal papillary mucinous neoplasm patients who underwent operative resection between July 1999 and March 2014. The frequencies, patterns, time-to-event, and risk factors for postoperative recurrence in intraductal papillary mucinous neoplasm were analyzed. RESULTS: Fifty-six intraductal papillary mucinous neoplasm patients (21.8%) had recurrence after the operation, including those with remnant pancreatic recurrence (n = 14) and extrapancreatic recurrence (n = 42). Remnant pancreatic recurrence had no influence on the overall survival, whereas patients with extrapancreatic recurrence had significantly worse overall survival (P < .001). Furthermore, the overall survival of intraductal papillary mucinous neoplasm patients with extrapancreatic recurrence was shorter than that for patients with remnant pancreatic recurrence (median overall survival: 21.8 versus 110.6 months; P < .001). Five patients experienced remnant pancreatic recurrence >5 years after the operation. All extrapancreatic recurrences occurred within 5 years. We found that the positive pancreatic transection margin was the only independent risk factor for remnant pancreatic recurrence (P < .001), whereas the risk factors for extrapancreatic recurrence were invasive intraductal papillary mucinous neoplasm (P < .001), mixed-type (P = .008), elevated serum CA19-9 (P = .019), and intraoperative transfusion (P = .025) in the multivariate analysis. CONCLUSION: Our data suggest that all intraductal papillary mucinous neoplasm patients should be subject to continual surveillance every 6 months for >5 years after operation to evaluate the remnant pancreatic recurrence; furthermore, the data indicate that strict 5-year surveillance, including every 3 months for 1 year after the operation and every 6 months thereafter, is necessary for intraductal papillary mucinous neoplasm patients at risk for extrapancreatic recurrence.
BACKGROUND: There is not enough evidence to establish an appropriate surveillance strategy after operative resection for intraductal papillary mucinous neoplasm. METHODS: This study included 257 consecutive intraductal papillary mucinous neoplasmpatients who underwent operative resection between July 1999 and March 2014. The frequencies, patterns, time-to-event, and risk factors for postoperative recurrence in intraductal papillary mucinous neoplasm were analyzed. RESULTS: Fifty-six intraductal papillary mucinous neoplasmpatients (21.8%) had recurrence after the operation, including those with remnant pancreatic recurrence (n = 14) and extrapancreatic recurrence (n = 42). Remnant pancreatic recurrence had no influence on the overall survival, whereas patients with extrapancreatic recurrence had significantly worse overall survival (P < .001). Furthermore, the overall survival of intraductal papillary mucinous neoplasmpatients with extrapancreatic recurrence was shorter than that for patients with remnant pancreatic recurrence (median overall survival: 21.8 versus 110.6 months; P < .001). Five patients experienced remnant pancreatic recurrence >5 years after the operation. All extrapancreatic recurrences occurred within 5 years. We found that the positive pancreatic transection margin was the only independent risk factor for remnant pancreatic recurrence (P < .001), whereas the risk factors for extrapancreatic recurrence were invasive intraductal papillary mucinous neoplasm (P < .001), mixed-type (P = .008), elevated serum CA19-9 (P = .019), and intraoperative transfusion (P = .025) in the multivariate analysis. CONCLUSION: Our data suggest that all intraductal papillary mucinous neoplasmpatients should be subject to continual surveillance every 6 months for >5 years after operation to evaluate the remnant pancreatic recurrence; furthermore, the data indicate that strict 5-year surveillance, including every 3 months for 1 year after the operation and every 6 months thereafter, is necessary for intraductal papillary mucinous neoplasmpatients at risk for extrapancreatic recurrence.
Authors: Ji Eun Kwon; Kee-Taek Jang; Youngju Ryu; Naru Kim; Sang Hyun Shin; Jin Seok Heo; Dong Wook Choi; In Woong Han Journal: Ann Hepatobiliary Pancreat Surg Date: 2019-11-29