Should non-invasive diffuse main-duct intraductal papillary mucinous neoplasms be treated with total pancreatectomy?. Issue 5 (May 2022)

• Record Type: Journal Article
• Authors: Blair, Alex B.; Beckman, Ross M.; Habib, Joseph R.; Griffin, James F.; Lafaro, Kelly; Burkhart, Richard A.; Burns, William; Weiss, Matthew J.; Cameron, John L.; Wolfgang, Christopher L.; He, Jin
• Is Part Of: HPB. Volume 24:Issue 5(2022)
• Page Start: 645
• Page End: 653
• Publication Date: 2022-05
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2021.09.013
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Main-duct (MD) intraductal papillary mucinous neoplasm (IPMN) is associated with malignancy risk. There is a lack of consensus on treatment (partial or total pancreatectomy) when the MD is diffusely involved. We sought to characterize the pancreatic remnant fate after partial pancreatectomy for non-invasive diffuse MD-IPMN. Methods: Consecutive patients with partial pancreatectomy for non-invasive MD-IPMN from 2004 to 2016 were analyzed. Diffuse MD-IPMN was defined by preoperative imaging as dilation of the MD in the head of the pancreas more than 5 mm and involving the whole gland. Results: Of 127 patients with resected non-invasive MD-IPMN, 47 (37%) had diffuse MD involvement. Eleven of 47(23%) patients developed imaging evidence of progression or new cystic disease in the pancreatic remnant. Patients with diffuse MD-IPMN were older (73yrs vs 67yrs, p = 0.009), more likely to receive a pancreaticoduodenectomy (96% vs 56%, p < 0.001) and have high-grade dysplasia (51% vs 31%, p = 0.025) than those with focal MD involvement. Diffuse MD involvement was not associated with shorter PFS following partial pancreatectomy (p = 0.613). Conclusion: Partial pancreatectomy is an appropriate surgical approach for diffuse MD-IPMN, and is not associated with earlier progression after surgery as compared to partial pancreatectomy for focal dilation.