SSAT - Risk Factors of the Recurrence After Surgical Resection for Intraductal Papillary Mucinous Neoplasm of the Pancreas

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Risk Factors of the Recurrence After Surgical Resection for Intraductal Papillary Mucinous Neoplasm of the Pancreas
Seiko Hirono^*, Manabu Kawai, Ken-ichi Okada, Motoki Miyazawa, Atsushi Shimizu, Yuji Kitahata, Hiroki Yamaue
Second of Surgery, Wakayama Medical University, Wakayama, Japan

Introduction: There has been little evidence about appropriate surveillance following surgical resection for intraductal papillary mucinous neoplasm (IPMN). We evaluate the risk factors of recurrence to establish the postoperative surveillance strategy for IPMN.
Methods: This study enrolled 257 IPMN patients undergoing surgical resection at a single institution. We analyzed the frequencies, patterns, time-to-event, and risk factors of the postoperative recurrence for IPMN.
Results: Fifty-five IPMN patients (21.4%) developed recurrence after surgery, including remnant pancreatic recurrence (n=14) and extra-pancreatic recurrence (n=41). The remnant pancreatic recurrence had no influence on the overall survival (OS), however, the OS of the patients with extra-pancreatic recurrence was significantly worse than those without (P<0.001). Five (35.7%) of 14 patients with remnant pancreatic recurrence developed it more than 5 years after surgery, and the OS of 8 patients undergoing the second resection tended to be better than 6 patients without. All extra-pancreatic recurrences occurred within 5 years, and especially, 85.4% of them occurred within 2 years from the surgery. We found that positive pancreatic transected margin was only independent risk factor of remnant pancreatic recurrence (P<0.001), and the risk factors of extra-pancreatic recurrence were invasive IPMN (P<0.001), mixed type (P=0.027), tumor size >30 mm (P=0.045), elevated serum CA19-9 (P=0.011), and intraoperative transfusion (P=0.010).
Conclusion: Our data suggest that continuous surveillance in more than 5 years are needed after surgery for all IPMN patients to evaluate the remnant pancreatic recurrence, and strict surveillance within 5 years for IPMN patients with risk factors of extra-pancreatic recurrence.

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