Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas

Thomas Schnelldorfer, Michael G. Sarr, David M. Nagorney, Lizhi Zhang, Thomas Christopher Smyrk, Rui Qin, Suresh T Chari, Michael B. Farnell

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Abstract

Hypothesis: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN. Design: Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation. Setting: Mayo Clinic Rochester, a tertiary care center. Patients: All patients who underwent primary resection for pancreatic IPMN. Main Outcome Measures: Disease-specific operative outcomes, survival, and recurrence patterns. Results: Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Reresection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P=.26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy. Conclusions: Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.

Original languageEnglish (US)
Pages (from-to)639-646
Number of pages8
JournalArchives of Surgery
Volume143
Issue number7
DOIs
StatePublished - Jul 2008

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Pancreatic Neoplasms
Pancreatectomy
Neoplasms
Recurrence
Survival
Adenocarcinoma
Carcinoma in Situ
Tertiary Care Centers
Adenoma
Pancreas
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

Schnelldorfer, T., Sarr, M. G., Nagorney, D. M., Zhang, L., Smyrk, T. C., Qin, R., ... Farnell, M. B. (2008). Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. Archives of Surgery, 143(7), 639-646. https://doi.org/10.1001/archsurg.143.7.639

Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. / Schnelldorfer, Thomas; Sarr, Michael G.; Nagorney, David M.; Zhang, Lizhi; Smyrk, Thomas Christopher; Qin, Rui; Chari, Suresh T; Farnell, Michael B.

In: Archives of Surgery, Vol. 143, No. 7, 07.2008, p. 639-646.

Research output: Contribution to journalArticle

Schnelldorfer, T, Sarr, MG, Nagorney, DM, Zhang, L, Smyrk, TC, Qin, R, Chari, ST & Farnell, MB 2008, 'Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas', Archives of Surgery, vol. 143, no. 7, pp. 639-646. https://doi.org/10.1001/archsurg.143.7.639
Schnelldorfer, Thomas ; Sarr, Michael G. ; Nagorney, David M. ; Zhang, Lizhi ; Smyrk, Thomas Christopher ; Qin, Rui ; Chari, Suresh T ; Farnell, Michael B. / Experience with 208 resections for intraductal papillary mucinous neoplasm of the pancreas. In: Archives of Surgery. 2008 ; Vol. 143, No. 7. pp. 639-646.
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abstract = "Hypothesis: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN. Design: Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation. Setting: Mayo Clinic Rochester, a tertiary care center. Patients: All patients who underwent primary resection for pancreatic IPMN. Main Outcome Measures: Disease-specific operative outcomes, survival, and recurrence patterns. Results: Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64{\%} in patients with main duct IPMN compared with 18{\%} in patients with branch duct IPMN. Reresection of the initial pancreatic margin was necessary in 21{\%} of patients. Final negative margins were achieved in 89{\%} of patients. Five-year survival with noninvasive IPMN was 94{\%}. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31{\%} vs 24{\%}; P=.26). In patients with invasive IPMN, 58{\%} experienced disease recurrence. In patients with noninvasive IPMN, 10{\%} experienced disease recurrence after partial pancreatectomy and 0{\%} experienced disease recurrence after total pancreatectomy. Conclusions: Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.",
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AU - Zhang, Lizhi

AU - Smyrk, Thomas Christopher

AU - Qin, Rui

AU - Chari, Suresh T

AU - Farnell, Michael B.

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N2 - Hypothesis: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN. Design: Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation. Setting: Mayo Clinic Rochester, a tertiary care center. Patients: All patients who underwent primary resection for pancreatic IPMN. Main Outcome Measures: Disease-specific operative outcomes, survival, and recurrence patterns. Results: Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Reresection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P=.26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy. Conclusions: Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.

AB - Hypothesis: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN. Design: Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation. Setting: Mayo Clinic Rochester, a tertiary care center. Patients: All patients who underwent primary resection for pancreatic IPMN. Main Outcome Measures: Disease-specific operative outcomes, survival, and recurrence patterns. Results: Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Reresection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P=.26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy. Conclusions: Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.

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