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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

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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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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Abbreviations

IPMN:

Intraductal papillary mucinous neoplasm

IPMC:

Intraductal papillary mucinous carcinoma

LGD:

Low-grade dysplasia

HGD:

High-grade dysplasia

PDAC:

Pancreatic ductal adenocarcinoma

ICG:

International consensus guideline

EUS:

Endoscopic ultrasonography

CT:

Computed tomography

MRI:

Magnetic resonance imaging

MPD:

Main pancreatic duct

MD type:

Main duct type

BD type:

Branch duct type

CEA:

Carcinoembryonic antigen

CA19-9:

Carbohydrate antigen 19-9

OS:

Overall survival

DFS:

Disease-free survival

LN:

Lymph node

HR:

Hazard ratio

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Acknowledgements

This work was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI Grant number JP19K08409. This study supported by the Japan Pancreas Society.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Seiko Hirono & Hiroki Yamaue

  2. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan

    Yasuhiro Shimizu

  3. Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Takao Ohtsuka & Masafumi Nakamura

  4. Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan

    Toshifumi Kin

  5. Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan

    Kazuo Hara

  6. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan

    Atsushi Kanno

  7. Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan

    Shinsuke Koshita

  8. Department of Gastroenterology, JA Onomichi General Hospital, Hiroshima, Japan

    Keiji Hanada

  9. Department of Gastroenterology and Hepatology, Kindai University School of Medicine, Higashiosaka, Japan

    Masayuki Kitano

  10. Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan

    Hiroyuki Inoue

  11. Department of Gastroenterology and Hepatology, Tokyo Medical University, Tokyo, Japan

    Takao Itoi

  12. Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan

    Toshiharu Ueki

  13. Clinical Study Support Center, School of Medicine, Wakayama Medical University, Wakayama, Japan

    Toshio Shimokawa

  14. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center, Tokyo, Japan

    Susumu Hijioka

  15. Department of Pathology, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Akio Yanagisawa

  16. Department of Gastroenterology and Hepatology, Kansai Medical University, Hirakata, Japan

    Kazuichi Okazaki

Authors
  1. Seiko Hirono
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  2. Yasuhiro Shimizu
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  3. Takao Ohtsuka
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  4. Toshifumi Kin
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  5. Kazuo Hara
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  18. Hiroki Yamaue
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Contributions

HY and SH had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: SH, YS, TO, SH, HY. Acquisition or interpretation of data: SH, YS, TO, TS, SH, AY, MN, KO, HY. Draft of the manuscript: SH, YS, TO, MN, HY. Critical revision of the manuscript for important intellectual content: SH, YS, TO, TS, HY. Administrative, technical, or material support: SH, TO, TK, KH, AK, SK, KH, MK, HI, TI, TU, SH, AY, HY. Study supervision: YS, TO, MN, HY.

Corresponding author

Correspondence to Hiroki Yamaue.

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The authors declare no financial interests or potential conflicts of interest.

Ethics approval

This retrospective study was approved by Internal Review Board of all participating institutes.

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Hirono, S., Shimizu, Y., Ohtsuka, T. et al. 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. J Gastroenterol 55, 86–99 (2020). https://doi.org/10.1007/s00535-019-01617-2

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