This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Surgical Oncology  • Surgical Interventions, Other  • Liver/ Biliary Tract/ Pancreatic Diseases  • Alert me on articles by topic

Thomas Schnelldorfer, MD; Michael G. Sarr, MD; David M. Nagorney, MD; Lizhi Zhang, MD; Thomas C. Smyrk, MD; Rui Qin, PhD; Suresh T. Chari, MD; Michael B. Farnell, MD

Arch Surg. 2008;143(7):639-646.

Hypothesis  Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN.

Design  Retrospective review from 1992 through 2005 with additional independent histopathologic confirmation.

Setting  Mayo Clinic Rochester, a tertiary care center.

Patients  All patients who underwent primary resection for pancreatic IPMN.

Main Outcome Measures  Disease-specific operative outcomes, survival, and recurrence patterns.

Results  Of 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Re-resection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P = .26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy.

Conclusions  Patients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.

Author Affiliations: Division of Gastroenterologic and General Surgery (Drs Schnelldorfer, Sarr, Nagorney, and Farnell), Department of Pathology (Drs Zhang and Smyrk), Division of Biostatistics (Dr Qin), and Department of Gastroenterology and Hepatology (Dr Chari), Mayo Clinic, Rochester, Minnesota.