Pre-emptive resection for intraductal papillary mucinous neoplasia - Long-term outcome is similar between non-invasive and early invasive lesions in a tertiary single center

Yasmine Djoumi; Omid Sadr-Azodi; Miroslav Vujasinovic; Marco Del Chiaro; Ernesto Sparrelid; Poya Ghorbani; Marcus Holmberg

doi:10.1016/j.pan.2023.03.007

Pre-emptive resection for intraductal papillary mucinous neoplasia - Long-term outcome is similar between non-invasive and early invasive lesions in a tertiary single center

Pancreatology. 2023 Jun;23(4):389-395. doi: 10.1016/j.pan.2023.03.007. Epub 2023 Mar 21.

Authors

Yasmine Djoumi¹, Omid Sadr-Azodi², Miroslav Vujasinovic³, Marco Del Chiaro⁴, Ernesto Sparrelid⁵, Poya Ghorbani⁵, Marcus Holmberg⁶

Affiliations

¹ Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden.
² Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, Capio S.t Görans Hospital, Stockholm, Sweden.
³ Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
⁴ Department of Surgery, University of Colorado, Anschutz Medical Campus, Denver, USA.
⁵ Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
⁶ Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Stockholm, Sweden; Department of Upper Gastrointestinal Surgery, Capio S.t Görans Hospital, Stockholm, Sweden. Electronic address: marcus.holmberg@ki.se.

PMID: 37002181
DOI: 10.1016/j.pan.2023.03.007

Abstract

Background: Pre-emptive resection for intraductal papillary mucinous neoplasm (IPMN) aims to reduce the risk before invasive transformation has taken place. Pancreatic resections are highly associated with major morbidity and mortality. Long-term overall survival (OS) after resection for invasive IPMN (inv-IPMN) in early stages is favorable. Comparison of long-term OS for resected non-invasive IPMN and early staged inv-IPMN is poorly delineated. This study aims to compare outcomes for resected non-invasive IPMN and T1-staged inv-IPMN.

Methods: All patients ≥18 years of age resected for IPMN up to stage T1 at Karolinska University Hospital between 2008 and 2020 were included. Two-year OS were compared between groups by chi-squared test, and 5-year OS was estimated using Kaplan-Meier method. Covariates associated with death was assessed in multivariable Cox regression model.

Results: We included 284 patients, 264 (93%) non-invasive IPMN and 20 (7%) T1-staged inv-IPMN. Dysplasia of low grade (LGD) and high grade, i.e., tumor in situ (Tis) were present in 190 (67%) and 75 (26%) patients respectively. The 2-year OS for the entire cohort was 96%, and there were no differences between non-invasive and inv-IPMN (96% vs 92%, p = 0.203), nor between IPMN with LGD and Tis-T1b-staged IPMN (96% vs 95%, p = 0.734).

Conclusion: Two thirds of the specimen from pre-emptive resections were of LGD and did not involve superior OS than in situ or early cancer. Due to high complication burden, efforts should be made to avoid resection when LGD is probable and rather identify more accurate predictors for surgery.

Keywords: Intraductal papillary mucinous neoplasm; Invasive; Pre-emptive; Survival.

MeSH terms

Carcinoma, Pancreatic Ductal* / pathology
Humans
Pancreatectomy / methods
Pancreatic Intraductal Neoplasms* / surgery
Pancreatic Neoplasms* / pathology
Retrospective Studies