Recurrence patterns after surgical resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas; a multicenter, retrospective study of 1074 IPMN patients by the Japan Pancreas Society

Seiko Hirono, Yasuhiro Shimizu, Takao Ohtsuka, Toshifumi Kin, Kazuo Hara, Atsushi Kanno, Shinsuke Koshita, Keiji Hanada, Masayuki Kitano, Hiroyuki Inoue, Takao Itoi, Toshiharu Ueki, Toshio Shimokawa, Susumu Hijioka, Akio Yanagisawa, Masafumi Nakamura, Kazuichi Okazaki, Hiroki Yamaue

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Abstract

Background: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. Methods: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. Results: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4%) developed postoperative recurrence. We found that 34.3% of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7%) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). Conclusion: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.

Original languageEnglish
Pages (from-to)86-99
Number of pages14
JournalJournal of gastroenterology
Volume55
Issue number1
DOIs
Publication statusPublished - Jan 1 2020

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Pancreatic Neoplasms
Multicenter Studies
Pancreas
Japan
Retrospective Studies
Recurrence
Neoplasms
Mucinous Adenocarcinoma
Carcinoma, Intraductal, Noninfiltrating
Papillary Carcinoma
Survival
Second Primary Neoplasms
Observational Studies
Adenocarcinoma

All Science Journal Classification (ASJC) codes

  • Gastroenterology

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Recurrence patterns after surgical resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas; a multicenter, retrospective study of 1074 IPMN patients by the Japan Pancreas Society. / Hirono, Seiko; Shimizu, Yasuhiro; Ohtsuka, Takao; Kin, Toshifumi; Hara, Kazuo; Kanno, Atsushi; Koshita, Shinsuke; Hanada, Keiji; Kitano, Masayuki; Inoue, Hiroyuki; Itoi, Takao; Ueki, Toshiharu; Shimokawa, Toshio; Hijioka, Susumu; Yanagisawa, Akio; Nakamura, Masafumi; Okazaki, Kazuichi; Yamaue, Hiroki.

In: Journal of gastroenterology, Vol. 55, No. 1, 01.01.2020, p. 86-99.

Research output: Contribution to journalArticle

Hirono, S, Shimizu, Y, Ohtsuka, T, Kin, T, Hara, K, Kanno, A, Koshita, S, Hanada, K, Kitano, M, Inoue, H, Itoi, T, Ueki, T, Shimokawa, T, Hijioka, S, Yanagisawa, A, Nakamura, M, Okazaki, K & Yamaue, H 2020, 'Recurrence patterns after surgical resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas; a multicenter, retrospective study of 1074 IPMN patients by the Japan Pancreas Society', Journal of gastroenterology, vol. 55, no. 1, pp. 86-99. https://doi.org/10.1007/s00535-019-01617-2
Hirono, Seiko ; Shimizu, Yasuhiro ; Ohtsuka, Takao ; Kin, Toshifumi ; Hara, Kazuo ; Kanno, Atsushi ; Koshita, Shinsuke ; Hanada, Keiji ; Kitano, Masayuki ; Inoue, Hiroyuki ; Itoi, Takao ; Ueki, Toshiharu ; Shimokawa, Toshio ; Hijioka, Susumu ; Yanagisawa, Akio ; Nakamura, Masafumi ; Okazaki, Kazuichi ; Yamaue, Hiroki. / Recurrence patterns after surgical resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas; a multicenter, retrospective study of 1074 IPMN patients by the Japan Pancreas Society. In: Journal of gastroenterology. 2020 ; Vol. 55, No. 1. pp. 86-99.
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abstract = "Background: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. Methods: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. Results: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4{\%}) developed postoperative recurrence. We found that 34.3{\%} of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7{\%}) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). Conclusion: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.",
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T1 - Recurrence patterns after surgical resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas; a multicenter, retrospective study of 1074 IPMN patients by the Japan Pancreas Society

AU - Hirono, Seiko

AU - Shimizu, Yasuhiro

AU - Ohtsuka, Takao

AU - Kin, Toshifumi

AU - Hara, Kazuo

AU - Kanno, Atsushi

AU - Koshita, Shinsuke

AU - Hanada, Keiji

AU - Kitano, Masayuki

AU - Inoue, Hiroyuki

AU - Itoi, Takao

AU - Ueki, Toshiharu

AU - Shimokawa, Toshio

AU - Hijioka, Susumu

AU - Yanagisawa, Akio

AU - Nakamura, Masafumi

AU - Okazaki, Kazuichi

AU - Yamaue, Hiroki

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. Methods: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. Results: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4%) developed postoperative recurrence. We found that 34.3% of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7%) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). Conclusion: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.

AB - Background: Although there are numerous reports focusing on surgical indication for intraductal papillary mucinous neoplasm (IPMN), the recurrence patterns following surgery are less widely reported. To ascertain optimal treatment and postoperative surveillance for IPMN patients, we analyzed patterns and risk factors for recurrence after surgery for IPMN. Methods: This study is a retrospective, multi-institutional, observational study, including 1074 patients undergoing surgery for IPMN at 11 academic institutions. We analyzed the risk factors for recurrence after classifying postoperative recurrences into metachronous high-risk lesions (malignant progression of IPMN and/or metachronous pancreatic ductal adenocarcinoma) in the remnant pancreas and extra-pancreatic recurrence. Results: Of 1074 patients undergoing surgery for IPMN, 155 patients (14.4%) developed postoperative recurrence. We found that 34.3% of 70 high-risk lesions in the remnant pancreas occurred over 5 years after surgery, and survival of 36 patients undergoing second operation for high-risk lesions was better than that of 34 patients who did not (P = 0.04). We found four independent risk factors for metachronous high-risk lesions in remnant pancreas: symptoms [P = 0.005, hazard ratio (HR) 1.988], location of pancreatic body/tail (P < 0.001, HR 3.876), main duct size ≥ 10 mm (P = 0.021, HR 1.900), and high-grade dysplasia/invasive intraductal papillary mucinous carcinoma (IPMC) (P < 0.001, HR 3.204). Although six patients (0.7%) with low- or high-grade dysplasia IPMN developed extra-pancreatic recurrence, invasive IPMC was the strongest risk factor for extra-pancreatic recurrence (P < 0.001, HR 39.667). Conclusion: We suggest that life-time continuous surveillance might be necessary for IPMN patients. Second surgery for metachronous high-risk lesions in remnant pancreas should be considered to improve survival.

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