Total Pancreatectomy for Presumed Intraductal Papillary Mucinous Neoplasms: A Multicentric Study of the French Surgical Association (AFC). Issue 5 (November 2018)

• Record Type: Journal Article
• Authors: Poiraud, Charles; El Amrani, Mehdi; Barbier, Louise; Chiche, Laurence; Mabrut, Jean Yves; Bachellier, Philippe; Pruvot, François-René; Delpero, Jean-Robert; Tuech, Jean Jacques; Adham, Mustapha; Sauvanet, Alain; Turrini, Olivier; Truant, Stéphanie
• Is Part Of: Annals of surgery. Volume 268:Issue 5(2018:Nov.)
• Publication Date: 2018-11
• Subjects: brittle diabetes -- IPMN -- outcome -- survival -- total pancreatectomy; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000002944
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of the current study was to assess the short and long-term outcome of total pancreatectomy (TP) for IPMN based on the largest series to date. Background: Literature data are scarce regarding TP for IPMN, though increasingly performed in this setting. Methods: Data of 888 IPMN patients operated between 2004 and 2013 were collected in a multicentric retrospective AFC database. Ninety-three patients (10.5%) who had TP entered this study. Patient demographics, indications, intraoperative data, 3-month morbi-mortality (Clavien), and long-term outcome were analyzed. Results: Most patients had mixed type IPMN (59%) and underwent upfront (56%) or intraoperatively-decided (33%) TP. Morbidity and mortality rates were 47.3% and 4.3%, respectively, with no lethal hypoglycemia; morbidity was higher for intraoperatively-decided TP. Misdiagnoses were frequent regarding main pancreatic duct involvement (12%), invasiveness (33%), or mural nodules (50%), resulting in 12 TPs (13%) performed for asymptomatic IPMN showing only low/moderate dysplasia (LMD). On histopathological examination, there were 54 (58%) invasive IPMN (mostly pT3/T4 (76%), N+ (60%), R0 (75%)), with a significantly worse 5-year survival (21.2%) compared to noninvasive group (85.7%; P < 0.0001). In the former, 24 (58.5%) developed recurrence showing mostly distant metastasis, within 2 years in 92%. Conclusion: This large series of TP for IPMN reported acceptable morbi-mortality rates with no long-term death from diabetes-related complication. Morphologic assessment was imperfectly reliable with 13% of TP done for LMD only. More than half of patients were operated at an invasive carcinoma stage with poor outcome. Conversely, long-term survival was excellent after TP for noninvasive IPMN. Abstract : Supplemental Digital Content is available in the text