Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm

Jacob R. Miller, Juliana E. Meyer, Joshua A. Waters, Mohammad Al-Haddad, John DeWitt, Stuart Sherman, Keith D. Lillemoe, C. Schmidt

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Objectives: Intraductual papillary mucinous neoplasms (IPMNs) are often multifocal and involve the entire pancreas. Because of the morbidity associated with total pancreatectomy, surgeons will perform segmental pancreatectomy, resecting only the most 'threatening' IPMN lesion(s). We sought to determine whether the presence of residual IPMN following segmental pancreatectomy for non-invasive IPMN increases the risk for subsequent development of invasive pancreatic cancer and decreases survival. Methods: Data on patients undergoing segmental resection of non-invasive IPMN during the period 1991-2010 at a high-volume academic institution were prospectively accrued. Results: Of 243 patients who underwent segmental resection for IPMN, 191 (79%) demonstrated non-invasive pathology. Of these, 153 (80%) showed the absence and 38 (20%) the presence of residual IPMN at the initial operation. Of the 38 patients with residual IPMN, eight had positive IPMN margins, 23 had radiographic evidence of IPMN, and seven had both. During a mean follow-up of 73 months, 31 (20%) of 153 patients without residual IPMN developed a new radiographic lesion consistent with IPMN and, of these, three (10%) were found to represent invasive cancer. One (3%) of 38 patients with residual IPMN developed invasive cancer. In summary, in 191 initially non-invasive cases of IPMN, four invasive cancers (2%) developed during follow-up. The mean progression-free interval in these four patients was 54 months (range: 20-99 months). Conclusions: Compared with patients undergoing complete operative IPMN clearance, patients with residual IPMN after segmental pancreatectomy do not demonstrate increased risk for the development of invasive disease or reduced survival. In patients without residual IPMN who later develop new IPMN, the risk for invasive IPMN is increased.

Original languageEnglish
Pages (from-to)759-766
Number of pages8
JournalHPB
Volume13
Issue number11
DOIs
StatePublished - Nov 2011

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Pancreatectomy
Neoplasms

Keywords

  • cystic tumours < pancreatic neoplasia
  • outcomes < pancreatic neoplasia
  • pancreatic neoplasia
  • radiologic imaging/intervention < pancreatic neoplasia
  • resection < pancreatic neoplasia

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm. / Miller, Jacob R.; Meyer, Juliana E.; Waters, Joshua A.; Al-Haddad, Mohammad; DeWitt, John; Sherman, Stuart; Lillemoe, Keith D.; Schmidt, C.

In: HPB, Vol. 13, No. 11, 11.2011, p. 759-766.

Research output: Contribution to journalArticle

Miller, Jacob R. ; Meyer, Juliana E. ; Waters, Joshua A. ; Al-Haddad, Mohammad ; DeWitt, John ; Sherman, Stuart ; Lillemoe, Keith D. ; Schmidt, C. / Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm. In: HPB. 2011 ; Vol. 13, No. 11. pp. 759-766.
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abstract = "Objectives: Intraductual papillary mucinous neoplasms (IPMNs) are often multifocal and involve the entire pancreas. Because of the morbidity associated with total pancreatectomy, surgeons will perform segmental pancreatectomy, resecting only the most 'threatening' IPMN lesion(s). We sought to determine whether the presence of residual IPMN following segmental pancreatectomy for non-invasive IPMN increases the risk for subsequent development of invasive pancreatic cancer and decreases survival. Methods: Data on patients undergoing segmental resection of non-invasive IPMN during the period 1991-2010 at a high-volume academic institution were prospectively accrued. Results: Of 243 patients who underwent segmental resection for IPMN, 191 (79{\%}) demonstrated non-invasive pathology. Of these, 153 (80{\%}) showed the absence and 38 (20{\%}) the presence of residual IPMN at the initial operation. Of the 38 patients with residual IPMN, eight had positive IPMN margins, 23 had radiographic evidence of IPMN, and seven had both. During a mean follow-up of 73 months, 31 (20{\%}) of 153 patients without residual IPMN developed a new radiographic lesion consistent with IPMN and, of these, three (10{\%}) were found to represent invasive cancer. One (3{\%}) of 38 patients with residual IPMN developed invasive cancer. In summary, in 191 initially non-invasive cases of IPMN, four invasive cancers (2{\%}) developed during follow-up. The mean progression-free interval in these four patients was 54 months (range: 20-99 months). Conclusions: Compared with patients undergoing complete operative IPMN clearance, patients with residual IPMN after segmental pancreatectomy do not demonstrate increased risk for the development of invasive disease or reduced survival. In patients without residual IPMN who later develop new IPMN, the risk for invasive IPMN is increased.",
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T1 - Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm

AU - Miller, Jacob R.

AU - Meyer, Juliana E.

AU - Waters, Joshua A.

AU - Al-Haddad, Mohammad

AU - DeWitt, John

AU - Sherman, Stuart

AU - Lillemoe, Keith D.

AU - Schmidt, C.

PY - 2011/11

Y1 - 2011/11

N2 - Objectives: Intraductual papillary mucinous neoplasms (IPMNs) are often multifocal and involve the entire pancreas. Because of the morbidity associated with total pancreatectomy, surgeons will perform segmental pancreatectomy, resecting only the most 'threatening' IPMN lesion(s). We sought to determine whether the presence of residual IPMN following segmental pancreatectomy for non-invasive IPMN increases the risk for subsequent development of invasive pancreatic cancer and decreases survival. Methods: Data on patients undergoing segmental resection of non-invasive IPMN during the period 1991-2010 at a high-volume academic institution were prospectively accrued. Results: Of 243 patients who underwent segmental resection for IPMN, 191 (79%) demonstrated non-invasive pathology. Of these, 153 (80%) showed the absence and 38 (20%) the presence of residual IPMN at the initial operation. Of the 38 patients with residual IPMN, eight had positive IPMN margins, 23 had radiographic evidence of IPMN, and seven had both. During a mean follow-up of 73 months, 31 (20%) of 153 patients without residual IPMN developed a new radiographic lesion consistent with IPMN and, of these, three (10%) were found to represent invasive cancer. One (3%) of 38 patients with residual IPMN developed invasive cancer. In summary, in 191 initially non-invasive cases of IPMN, four invasive cancers (2%) developed during follow-up. The mean progression-free interval in these four patients was 54 months (range: 20-99 months). Conclusions: Compared with patients undergoing complete operative IPMN clearance, patients with residual IPMN after segmental pancreatectomy do not demonstrate increased risk for the development of invasive disease or reduced survival. In patients without residual IPMN who later develop new IPMN, the risk for invasive IPMN is increased.

AB - Objectives: Intraductual papillary mucinous neoplasms (IPMNs) are often multifocal and involve the entire pancreas. Because of the morbidity associated with total pancreatectomy, surgeons will perform segmental pancreatectomy, resecting only the most 'threatening' IPMN lesion(s). We sought to determine whether the presence of residual IPMN following segmental pancreatectomy for non-invasive IPMN increases the risk for subsequent development of invasive pancreatic cancer and decreases survival. Methods: Data on patients undergoing segmental resection of non-invasive IPMN during the period 1991-2010 at a high-volume academic institution were prospectively accrued. Results: Of 243 patients who underwent segmental resection for IPMN, 191 (79%) demonstrated non-invasive pathology. Of these, 153 (80%) showed the absence and 38 (20%) the presence of residual IPMN at the initial operation. Of the 38 patients with residual IPMN, eight had positive IPMN margins, 23 had radiographic evidence of IPMN, and seven had both. During a mean follow-up of 73 months, 31 (20%) of 153 patients without residual IPMN developed a new radiographic lesion consistent with IPMN and, of these, three (10%) were found to represent invasive cancer. One (3%) of 38 patients with residual IPMN developed invasive cancer. In summary, in 191 initially non-invasive cases of IPMN, four invasive cancers (2%) developed during follow-up. The mean progression-free interval in these four patients was 54 months (range: 20-99 months). Conclusions: Compared with patients undergoing complete operative IPMN clearance, patients with residual IPMN after segmental pancreatectomy do not demonstrate increased risk for the development of invasive disease or reduced survival. In patients without residual IPMN who later develop new IPMN, the risk for invasive IPMN is increased.

KW - cystic tumours < pancreatic neoplasia

KW - outcomes < pancreatic neoplasia

KW - pancreatic neoplasia

KW - radiologic imaging/intervention < pancreatic neoplasia

KW - resection < pancreatic neoplasia

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