A Clinicopathologic Analysis of 63 Cases of Intraductal Papillary Mucinous Neoplasm of the Pancreas
Abstracts
|
Introduction: Intraductal Papillary Mucinous Neoplasms of the Pancreas (IPMN) are rare neoplasms that have not been well characterized and whose surgical management remains controversial. Methods: A prospective pancreatic database was reviewed to identify patients with IPMN who were surgically managed. Pathologic re-review of each case was performed and the clinicopathologic features were examined. Log rank and chi-square analysis were used to identify factors predictive of survival and recurrence. Results: From 10/83 to 12/00, 63 patients were identified. The median age was 70 (41-87) and 32 patients (51%) were female. Seventeen patients (24%) presented with an elevated total bilirubin. One patient was unresectable at operation, 6 (10%)underwent a total pancreatectomy and 56 (88%) underwent a regional pancreatic resection. Invasive carcinoma was present in 30 patients (48%) and 10 patients (16%) had lymph node metastases. Vascular invasion was present in 4 specimens (7%). Margins were involved with atypia or carcinoma in 19 patients (31%). The median follow-up for survivors was 32 months. Fourteen patients (23%) have recurred with a median time to recurrence of 20 months (8-70). Disease specific 5 and 10 year survival was 75% and 60% for the whole group and 55% and 41% for those with an invasive component. Significant predictors of poor outcome included presentation with elevated bilirubin, presence of invasive carcinoma, increasing size and percentage of invasive carcinoma, positive lymph nodes and vascular invasion. Among the patients with invasive carcinoma, presentation with an elevated bilirubin, positive lymph nodes, and vascular invasion continued to predict a poor outcome. The presence of atypia or carcinoma at the resection margin did not correlate with risk of recurrence. Conclusions: Overall, IPMN has a favorable prognosis. Poor outcome, in a subset of patients, is largely due to the presence and degree of an invasive component, lymph node metastases and vascular invasion. Elevated bilirubin at presentation is a useful clinical marker of poor prognosis. Grossly normal margins are likely to be adequate for resection of IPMN, although further followup is necessary to better define this issue. |
