Seiko Hirono1, Yasuhiro Shimizu2, Takao Ohtsuka3, Toshifumi Kin4, Kazuo Hara5, Atsushi Kanno6, Shinsuke Koshita7, Keiji Hanada8, Masayuki Kitano9, Hiroyuki Inoue10, Takao Itoi11, Toshiharu Ueki12, Toshio Shimokawa13, Susumu Hijioka14, Akio Yanagisawa15, Masafumi Nakamura3, Kazuichi Okazaki16, Hiroki Yamaue17. 1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan. 2. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan. 3. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 4. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan. 5. Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan. 6. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 7. Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan. 8. Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan. 9. Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Higashiosaka, Japan. 10. Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan. 11. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan. 12. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan. 13. Clinical Study Support Center, School of Medicine, Wakayama Medical University, Wakayama, Japan. 14. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center, Tokyo, Japan. 15. Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 16. Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan. 17. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan. yamaue-h@wakayama-med.ac.jp.
Abstract
BACKGROUND: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. METHODS: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. RESULTS: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4%) developed postoperative recurrence. We found that 34.3% of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7%) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). CONCLUSION: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.
BACKGROUND: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. METHODS: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. RESULTS: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4%) developed postoperative recurrence. We found that 34.3% of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7%) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). CONCLUSION: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.
Entities:
Keywords:
Extra-pancreatic recurrence; High-risk lesions in the remnant pancreas; IPMN; Overall survival; Recurrence; Risk factor
Authors: Olca Basturk; Seung-Mo Hong; Laura D Wood; N Volkan Adsay; Jorge Albores-Saavedra; Andrew V Biankin; Lodewijk A A Brosens; Noriyoshi Fukushima; Michael Goggins; Ralph H Hruban; Yo Kato; David S Klimstra; Günter Klöppel; Alyssa Krasinskas; Daniel S Longnecker; Hanno Matthaei; G Johan A Offerhaus; Michio Shimizu; Kyoichi Takaori; Benoit Terris; Shinichi Yachida; Irene Esposito; Toru Furukawa Journal: Am J Surg Pathol Date: 2015-12 Impact factor: 6.394
Authors: Antonio Pea; Jun Yu; Neda Rezaee; Claudio Luchini; Jin He; Marco Dal Molin; James F Griffin; Helen Fedor; Shahriar Fesharakizadeh; Roberto Salvia; Matthew J Weiss; Claudio Bassi; John L Cameron; Lei Zheng; Aldo Scarpa; Ralph H Hruban; Anne Marie Lennon; Michael Goggins; Christopher L Wolfgang; Laura D Wood Journal: Ann Surg Date: 2017-07 Impact factor: 12.969
Authors: Marc A Attiyeh; Carlos Fernández-Del Castillo; Mohammad Al Efishat; Anne A Eaton; Mithat Gönen; Ruqayyah Batts; Ilaria Pergolini; Neda Rezaee; Keith D Lillemoe; Cristina R Ferrone; Mari Mino-Kenudson; Matthew J Weiss; John L Cameron; Ralph H Hruban; Michael I D'Angelica; Ronald P DeMatteo; T Peter Kingham; William R Jarnagin; Christopher L Wolfgang; Peter J Allen Journal: Ann Surg Date: 2018-01 Impact factor: 12.969
Authors: Stefano Partelli; Carlos Fernandez-Del Castillo; Claudio Bassi; William Mantovani; Sarah P Thayer; Stefano Crippa; Cristina R Ferrone; Massimo Falconi; Paolo Pederzoli; Andrew L Warshaw; Roberto Salvia Journal: Ann Surg Date: 2010-03 Impact factor: 12.969
Authors: Giovanni Marchegiani; Mari Mino-Kenudson; Cristina R Ferrone; Vicente Morales-Oyarvide; Andrew L Warshaw; Keith D Lillemoe; Carlos Fernández-Del Castillo Journal: Ann Surg Date: 2015-12 Impact factor: 12.969
Authors: Mari Mino-Kenudson; Carlos Fernández-del Castillo; Yoshifumi Baba; Nakul P Valsangkar; Andrew S Liss; Maylee Hsu; Camilo Correa-Gallego; Thun Ingkakul; Rocio Perez Johnston; Brian G Turner; Vasiliki Androutsopoulos; Vikram Deshpande; Deborah McGrath; Dushyant V Sahani; William R Brugge; Shuji Ogino; Martha B Pitman; Andrew L Warshaw; Sarah P Thayer Journal: Gut Date: 2011-04-20 Impact factor: 23.059
Authors: Joseph R Habib; Benedict Kinny-Köster; Neda Amini; Sami Shoucair; John L Cameron; Elizabeth D Thompson; Elliot K Fishman; Ralph H Hruban; Ammar A Javed; Jin He; Christopher L Wolfgang Journal: J Gastrointest Surg Date: 2022-08-01 Impact factor: 3.267
Authors: Michael J Pflüger; James F Griffin; Wenzel M Hackeng; Satomi Kawamoto; Jun Yu; Peter Chianchiano; Eunice Shin; Gemma Lionheart; Hua-Ling Tsai; Hao Wang; Neda Rezaee; Richard A Burkhart; John L Cameron; Elizabeth D Thompson; Christopher L Wolfgang; Jin He; Lodewijk A A Brosens; Laura D Wood Journal: Ann Surg Date: 2020-11-17 Impact factor: 13.787
Authors: Elizabeth D Thompson; Nicholas J Roberts; Laura D Wood; James R Eshleman; Michael G Goggins; Scott E Kern; Alison P Klein; Ralph H Hruban Journal: Mod Pathol Date: 2020-07-23 Impact factor: 7.842
Authors: Naziheh Assarzadegan; Elizabeth Thompson; Kevan Salimian; Matthias M Gaida; Lodewijk A A Brosens; Laura Wood; Syed Z Ali; Ralph H Hruban Journal: Langenbecks Arch Surg Date: 2021-05-28 Impact factor: 2.895
Authors: Thiago Bassaneze; Alberto Youssef Laham; Luiz Guilherme Lisboa Gomes; Bruna Queiroz Coelho; Carlos Augusto Real Martinez Journal: Int J Surg Case Rep Date: 2020-09-24