Pancreatic resection for intraductal papillary mucinous neoplasm– a thirteen-year single center experience

BMC Cancer

Research Article

Hans Joerg Mischinger¹  Katharina Marsoner¹  Jakob Schagerl¹  Peter Kornprat¹  James Elvis Waha¹  Dora Csengeri¹  Rainer Langeder¹  Johannes Haybaeck² 

[1] Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria;Institute of Pathology, Medical University of Graz, Graz, Austria;

关键词: Invasive intraductal papillary mucinous neoplasm (IPMN);    Non-invasive IPMN;    Invasive IPMN;    IPMN associated carcinoma;    Pancreatic resection;    Perioperative outcome;    Long-term survival;   

DOI  :  10.1186/s12885-016-2887-8

 received in 2016-05-11, accepted in 2016-10-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundThe purpose of this study is to review our results for pancreatic resection in patients with intraductal papillary mucinous neoplasm (IPMN) with and without associated carcinoma.MethodsA total of 54 patients undergoing pancreatic resection for IPMN in a single university surgical center (Medical University of Graz) were reviewed retrospectively. Their survival rates were compared to those of patients with pancreatic ductal adenocarcinoma.ResultsTwenty-four patients exhibit non-invasive IPMN and thirty patients invasive IPMN with associated carcinoma. The mean age is 67 (+/-11) years, 43 % female. Surgical strategies include classical or pylorus-preserving Whipple procedure (n = 30), distal (n = 13) or total pancreatectomy (n = 11), and additional portal venous resection in three patients (n = 3). Median intensive care stay is three days (range 1 – 87), median in hospital stay is 23 days (range 7 – 87). Thirty-day mortality is 3.7 %. Median follow up is 42 months (range 0 – 127). One-, five- and ten-year overall actuarial survival is 87 %; 84 % and 51 % respectively. Median overall survival is 120 months. Patients with non-invasive IPMN have significantly better survival than patients with invasive IPMN and IPMN-associated carcinoma (p < 0.008). In the subgroup of invasive IPMN with associated carcinoma, a positive nodal state, perineural invasion as well as lymphovascular infiltration are associated with poor outcome (p < 0.0001; <0.0001 and =0.001, respectively). Elevated CA 19-9(>37 U/l) as well as elevated lipase (>60 U/l) serum levels are associated with unfavorable outcome (p = 0.009 and 0.018; respectively). Patients operated for pancreatic ductal adenocarcinoma show significantly shorter long-term survival than patients with IPMN associated carcinoma (p = 0.001).ConclusionsLong-term outcome after pancreatic resection for non-invasive IPMN is excellent. Outcome after resection for invasive IPMN with invasive carcinoma is significantly better than for pancreatic ductal adenocarcinoma. In low- and intermediate risk IPMN with no clear indication for immediate surgical resection, a watchful waiting strategy should be evaluated carefully against surgical treatment individually for each patient.

【 授权许可】

CC BY   
© The Author(s). 2016