Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: A retrospective review

Koji Tamura, Takao Ohtsuka, Noboru Ideno, Teppei Aso, Koji Shindo, Shinichi Aishima, Kenoki Ohuchida, Shunichi Takahata, Yasuhiro Ushijima, Tetsuhide Ito, Yoshinao Oda, Kazuhiro Mizumoto, Masao Tanaka

研究成果: ジャーナルへの寄稿評論記事

44 引用 (Scopus)

抄録

OBJECTIVES:: To clarify the recurrence pattern after resection of main duct intraductal papillary mucinous neoplasms (MD-IPMNs) using molecular analyses and determine the most adequate treatment strategy. BACKGROUND:: The most appropriate resection line for MD-IPMNs remains an unresolved issue. METHODS:: Medical records of 56 patients with pancreatectomy were retrospectively reviewed. Histological subtypes and Kras/GNAS mutations were assessed in patients with recurrence in the remnant pancreas. RESULTS:: Forty-nine patients underwent partial pancreatectomy and 7 underwent total pancreatectomy. Thirty-six patients (64%) had malignant MD-IPMNs. Recurrence was observed in 7 of 49 patients (14%), including 6 with malignant IPMNs and 1 with pancreatic ductal adenocarcinoma, all of whom underwent remnant pancreatectomy. The cumulative disease-specific survival rate of patients with pancreatic recurrence was greater than that of patients with extrapancreatic recurrence (P < 0.001). Although the pancreatic margin status at the initial operation did not affect the pancreatic recurrence rate, all 4 recurrent IPMNs examined had histological subtypes and Kras/GNAS mutations identical to those of the initial lesions. Four patients experienced recurrence in the remnant pancreas or systemic recurrence after resection of high-grade dysplasia of MD-IPMN. Three of the 56 patients had concomitant pancreatic ductal adenocarcinomas and MD-IPMNs. CONCLUSIONS:: One-step total pancreatectomy can be avoided, and remnant total pancreatectomy would lead to favorable outcomes even in patients with pancreatic recurrence, some cases of which seem to involve residual lesions. Postoperative surveillance of high-grade dysplasia should be performed as if malignant, and close attention should be paid to the occurrence of concomitant pancreatic ductal adenocarcinomas in patients with MD-IPMNs.

元の言語英語
ページ(範囲)360-368
ページ数9
ジャーナルAnnals of Surgery
259
発行部数2
DOI
出版物ステータス出版済み - 2 1 2014

Fingerprint

Pancreatic Neoplasms
Pancreas
Pancreatectomy
Recurrence
Therapeutics
Neoplasms
Adenocarcinoma
Mutation
Medical Records
Survival Rate

All Science Journal Classification (ASJC) codes

  • Surgery

これを引用

Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection : A retrospective review. / Tamura, Koji; Ohtsuka, Takao; Ideno, Noboru; Aso, Teppei; Shindo, Koji; Aishima, Shinichi; Ohuchida, Kenoki; Takahata, Shunichi; Ushijima, Yasuhiro; Ito, Tetsuhide; Oda, Yoshinao; Mizumoto, Kazuhiro; Tanaka, Masao.

:: Annals of Surgery, 巻 259, 番号 2, 01.02.2014, p. 360-368.

研究成果: ジャーナルへの寄稿評論記事

@article{909863a36fc7411fb2eddf107f66b58e,
title = "Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: A retrospective review",
abstract = "OBJECTIVES:: To clarify the recurrence pattern after resection of main duct intraductal papillary mucinous neoplasms (MD-IPMNs) using molecular analyses and determine the most adequate treatment strategy. BACKGROUND:: The most appropriate resection line for MD-IPMNs remains an unresolved issue. METHODS:: Medical records of 56 patients with pancreatectomy were retrospectively reviewed. Histological subtypes and Kras/GNAS mutations were assessed in patients with recurrence in the remnant pancreas. RESULTS:: Forty-nine patients underwent partial pancreatectomy and 7 underwent total pancreatectomy. Thirty-six patients (64{\%}) had malignant MD-IPMNs. Recurrence was observed in 7 of 49 patients (14{\%}), including 6 with malignant IPMNs and 1 with pancreatic ductal adenocarcinoma, all of whom underwent remnant pancreatectomy. The cumulative disease-specific survival rate of patients with pancreatic recurrence was greater than that of patients with extrapancreatic recurrence (P < 0.001). Although the pancreatic margin status at the initial operation did not affect the pancreatic recurrence rate, all 4 recurrent IPMNs examined had histological subtypes and Kras/GNAS mutations identical to those of the initial lesions. Four patients experienced recurrence in the remnant pancreas or systemic recurrence after resection of high-grade dysplasia of MD-IPMN. Three of the 56 patients had concomitant pancreatic ductal adenocarcinomas and MD-IPMNs. CONCLUSIONS:: One-step total pancreatectomy can be avoided, and remnant total pancreatectomy would lead to favorable outcomes even in patients with pancreatic recurrence, some cases of which seem to involve residual lesions. Postoperative surveillance of high-grade dysplasia should be performed as if malignant, and close attention should be paid to the occurrence of concomitant pancreatic ductal adenocarcinomas in patients with MD-IPMNs.",
author = "Koji Tamura and Takao Ohtsuka and Noboru Ideno and Teppei Aso and Koji Shindo and Shinichi Aishima and Kenoki Ohuchida and Shunichi Takahata and Yasuhiro Ushijima and Tetsuhide Ito and Yoshinao Oda and Kazuhiro Mizumoto and Masao Tanaka",
year = "2014",
month = "2",
day = "1",
doi = "10.1097/SLA.0b013e3182a690ff",
language = "English",
volume = "259",
pages = "360--368",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection

T2 - A retrospective review

AU - Tamura, Koji

AU - Ohtsuka, Takao

AU - Ideno, Noboru

AU - Aso, Teppei

AU - Shindo, Koji

AU - Aishima, Shinichi

AU - Ohuchida, Kenoki

AU - Takahata, Shunichi

AU - Ushijima, Yasuhiro

AU - Ito, Tetsuhide

AU - Oda, Yoshinao

AU - Mizumoto, Kazuhiro

AU - Tanaka, Masao

PY - 2014/2/1

Y1 - 2014/2/1

N2 - OBJECTIVES:: To clarify the recurrence pattern after resection of main duct intraductal papillary mucinous neoplasms (MD-IPMNs) using molecular analyses and determine the most adequate treatment strategy. BACKGROUND:: The most appropriate resection line for MD-IPMNs remains an unresolved issue. METHODS:: Medical records of 56 patients with pancreatectomy were retrospectively reviewed. Histological subtypes and Kras/GNAS mutations were assessed in patients with recurrence in the remnant pancreas. RESULTS:: Forty-nine patients underwent partial pancreatectomy and 7 underwent total pancreatectomy. Thirty-six patients (64%) had malignant MD-IPMNs. Recurrence was observed in 7 of 49 patients (14%), including 6 with malignant IPMNs and 1 with pancreatic ductal adenocarcinoma, all of whom underwent remnant pancreatectomy. The cumulative disease-specific survival rate of patients with pancreatic recurrence was greater than that of patients with extrapancreatic recurrence (P < 0.001). Although the pancreatic margin status at the initial operation did not affect the pancreatic recurrence rate, all 4 recurrent IPMNs examined had histological subtypes and Kras/GNAS mutations identical to those of the initial lesions. Four patients experienced recurrence in the remnant pancreas or systemic recurrence after resection of high-grade dysplasia of MD-IPMN. Three of the 56 patients had concomitant pancreatic ductal adenocarcinomas and MD-IPMNs. CONCLUSIONS:: One-step total pancreatectomy can be avoided, and remnant total pancreatectomy would lead to favorable outcomes even in patients with pancreatic recurrence, some cases of which seem to involve residual lesions. Postoperative surveillance of high-grade dysplasia should be performed as if malignant, and close attention should be paid to the occurrence of concomitant pancreatic ductal adenocarcinomas in patients with MD-IPMNs.

AB - OBJECTIVES:: To clarify the recurrence pattern after resection of main duct intraductal papillary mucinous neoplasms (MD-IPMNs) using molecular analyses and determine the most adequate treatment strategy. BACKGROUND:: The most appropriate resection line for MD-IPMNs remains an unresolved issue. METHODS:: Medical records of 56 patients with pancreatectomy were retrospectively reviewed. Histological subtypes and Kras/GNAS mutations were assessed in patients with recurrence in the remnant pancreas. RESULTS:: Forty-nine patients underwent partial pancreatectomy and 7 underwent total pancreatectomy. Thirty-six patients (64%) had malignant MD-IPMNs. Recurrence was observed in 7 of 49 patients (14%), including 6 with malignant IPMNs and 1 with pancreatic ductal adenocarcinoma, all of whom underwent remnant pancreatectomy. The cumulative disease-specific survival rate of patients with pancreatic recurrence was greater than that of patients with extrapancreatic recurrence (P < 0.001). Although the pancreatic margin status at the initial operation did not affect the pancreatic recurrence rate, all 4 recurrent IPMNs examined had histological subtypes and Kras/GNAS mutations identical to those of the initial lesions. Four patients experienced recurrence in the remnant pancreas or systemic recurrence after resection of high-grade dysplasia of MD-IPMN. Three of the 56 patients had concomitant pancreatic ductal adenocarcinomas and MD-IPMNs. CONCLUSIONS:: One-step total pancreatectomy can be avoided, and remnant total pancreatectomy would lead to favorable outcomes even in patients with pancreatic recurrence, some cases of which seem to involve residual lesions. Postoperative surveillance of high-grade dysplasia should be performed as if malignant, and close attention should be paid to the occurrence of concomitant pancreatic ductal adenocarcinomas in patients with MD-IPMNs.

UR - http://www.scopus.com/inward/record.url?scp=84892941095&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892941095&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e3182a690ff

DO - 10.1097/SLA.0b013e3182a690ff

M3 - Review article

AN - SCOPUS:84892941095

VL - 259

SP - 360

EP - 368

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -