Prognostic impact of conservative surgery for pancreatic IPMNs.

Abstract

BACKGROUND:

The extent of pancreatic resection for intraductal papillary mucinous neoplasms (IPMNs) remains an unresolved issue. The study aims at analyzing the prognostic impact of conservative surgery (CS) i.e. of pancreatoduodenectomy or distal pancreatectomy, versus total pancreatectomy (TP), for pancreatic IPMNs.

METHODS:

We retrospectively analyzed and compared data of patients who had undergone pancreatic resection for IPMNs at our center between November 2007 and April 2019. Patients were divided into two main groups based on the extent of surgery: TP-group and CS-group. Subsequently, the perioperative and the long-term outcomes were compared. Moreover, a sub-group analysis of patients with IPMN alone and patients with malignant IPMN, based on preoperative indications to surgery and post-operative histopathological findings, was also performed.

RESULTS:

Fifty-three patients were included in the TP-group and 73 in the CS-group. In 50 (39.7%) cases the frozen section changed the pre-operative surgical planning, with an extension of the pancreatic resection, in 43 (34.1%) cases up to a total pancreatectomy. Twenty-six patients (20.6%) with low-grade dysplasia at the frozen section underwent CS, while twenty (15.8%) underwent TP. Comparing these two sub-groups no differences were found in surgical IPMN recurrence, nor progression. The rate of overall postoperative complications was 56.6% in the TP-group and 57.5% in the CS-group (p = 0.940). Fifteen patients (20.5%) developed diabetes in the CS-group. None of the patients treated with CS developed a surgical IPMN recurrence or progression during the follow-up period. Comparing OS and DFS of the two groups, we did not find any statistically significant difference (p = 0.619 and 0.315).

CONCLUSION:

A timely CS can be considered an appropriate and valid strategy in the surgical treatment of the majority of pancreatic IPMNs, as it can avoid the serious long-term metabolic consequences of TP in patients with a long-life expectancy. On the contrary, TP remains mandatory in case of PDAC or high-risk features involving the entire gland.

• Authors: Matteo Palmeri, Gregorio Di Franco, Matteo Bianchini, Simone Guadagni, Desirée Gianardi, Niccolò Furbetta, Giovanni Caprili, Lorenzo Maria Fatucchi, Andrea Sbrana, Niccola Funel, Luca Emanuele Pollina, Giulio Di Candio, Luca Morelli
• Journal: Surgical oncology (Surg Oncol) Vol. 38 Pg. 101582 (Sep 2021) ISSN: 1879-3320 [Electronic] Netherlands
• PMID: 33892432 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Ltd. All rights reserved.

Topics

• Aged
• Carcinoma, Pancreatic Ductal (pathology, surgery)
• Female
• Follow-Up Studies
• Humans
• Male
• Neoplasm Recurrence, Local (pathology, surgery)
• Pancreatectomy (mortality)
• Pancreatic Intraductal Neoplasms (pathology, surgery)
• Pancreatic Neoplasms (pathology, surgery)
• Pancreaticoduodenectomy (mortality)
• Prognosis
• Retrospective Studies
• Survival Rate