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Outcomes following resection of invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas.

Wada K, Kozarek RA, William Traverso L

Department of General Surgery, Virginia Mason Medical Center, 1100 Ninth Ave., C6-GSURG, Seattle, WA 98111, USA.

BACKGROUND: Since any intraductal papillary mucinous neoplasm (IPMN) is at least premalignant, avoiding conversion to invasion by pancreatic resection should provide a survival advantage-but how much? METHODS: We reviewed 100 cases of IPMN that were resected. Survival was compared between 3 groups: noninvasive IPMN (n = 75), invasive IPMN (n = 25), and invasive ductal adenocarcinoma (n = 24), the latter matched by tumor-node-metastasis (TNM) stage to the IPMN invasive group. RESULTS: The 5-year disease-specific survival was significantly better for the noninvasive IPMN group (100%) than the invasive IPMN group (46%). Tumor recurrence was infrequent with noninvasive IPMNs (1.3% benign IPMN). Recurrence was common in the invasive IPMN group (46%). Even the subgroup with stage 1 disease had a 25% recurrence of malignancy. Survival curves were not different (P = .11) between the cases matched by stage for those with invasive IPMN cases versus cases with ductal adenocarcinoma. CONCLUSION: Patients with the invasive form of IPMN will have a similarly poor survival as those with ductal adenocarcinoma. In patients thought to have a benign IPMN, these lesions should be removed to avoid conversion to invasive cancer and to preserve the opportunity for the more favorable prognosis observed in this study.

Published 2 May 2005 in Am J Surg, 189(5): 632-6; discussion 637.
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