Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?

Jin He, John L. Cameron, Nita Ahuja, Martin A. Makary, Kenzo Hirose, Michael A. Choti, Richard D. Schulick, Ralph H. Hruban, Timothy M. Pawlik, Christopher L. Wolfgang

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Abstract

Background: Little is known about the risk of subsequently developing a new or progressive intraductal papillary mucinous neoplasm (IPMN) after partial pancreatic resection of a noninvasive IPMN. Study Design: One hundred thirty patients with more than 1 year of follow-up after resection were included in this analysis. Results: At a median follow-up of 38 months, 22 (17%) developed imaging evidence of a new or progressive IPMN. Eleven (8%) underwent completion resection. Three of the 11 patients had invasive adenocarcinoma. Two other patients developed metastatic pancreatic adenocarcinoma and did not undergo resection. All 5 patients (4%) with cancer had negative margins at initial operation. Sixteen of 100 patients (16%) with negative margins for IPMN at the initial operation developed a new IPMN vs 6 of 30 patients (20%) with margins positive for IPMN (p = ns). Five of 22 patients (23%) with a new IPMN had a family history of pancreatic cancer, while 8 of 108 patients (7%) without a new IPMN had a family history (p < 0.05). Overall, the chances of developing a new IPMN at 1, 5, and 10 years after the initial surgery were 4%, 25%, and 62%, respectively, and of requiring surgery were 1.6%, 14%, and 18%, respectively. The estimated chances of developing invasive pancreatic cancer were 0%, 7%, and 38% at 1, 5, and 10 years, respectively. Conclusions: Patients who have undergone resection for noninvasive IPMN require indefinite close surveillance because of the risks of developing a new IPMN, of requiring surgery, and of developing cancer. A family history of pancreatic cancer, but not margin status or degree of dysplasia, is associated with a risk of development of a new or progressive IPMN.

Original languageEnglish (US)
Pages (from-to)657-667
Number of pages11
JournalJournal of the American College of Surgeons
Volume216
Issue number4
DOIs
StatePublished - Apr 2013

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Neoplasms
Pancreatic Neoplasms
Adenocarcinoma

ASJC Scopus subject areas

  • Surgery

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Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? / He, Jin; Cameron, John L.; Ahuja, Nita; Makary, Martin A.; Hirose, Kenzo; Choti, Michael A.; Schulick, Richard D.; Hruban, Ralph H.; Pawlik, Timothy M.; Wolfgang, Christopher L.

In: Journal of the American College of Surgeons, Vol. 216, No. 4, 04.2013, p. 657-667.

Research output: Contribution to journalArticle

He, J, Cameron, JL, Ahuja, N, Makary, MA, Hirose, K, Choti, MA, Schulick, RD, Hruban, RH, Pawlik, TM & Wolfgang, CL 2013, 'Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?', Journal of the American College of Surgeons, vol. 216, no. 4, pp. 657-667. https://doi.org/10.1016/j.jamcollsurg.2012.12.026
He, Jin ; Cameron, John L. ; Ahuja, Nita ; Makary, Martin A. ; Hirose, Kenzo ; Choti, Michael A. ; Schulick, Richard D. ; Hruban, Ralph H. ; Pawlik, Timothy M. ; Wolfgang, Christopher L. / Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?. In: Journal of the American College of Surgeons. 2013 ; Vol. 216, No. 4. pp. 657-667.
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title = "Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?",
abstract = "Background: Little is known about the risk of subsequently developing a new or progressive intraductal papillary mucinous neoplasm (IPMN) after partial pancreatic resection of a noninvasive IPMN. Study Design: One hundred thirty patients with more than 1 year of follow-up after resection were included in this analysis. Results: At a median follow-up of 38 months, 22 (17{\%}) developed imaging evidence of a new or progressive IPMN. Eleven (8{\%}) underwent completion resection. Three of the 11 patients had invasive adenocarcinoma. Two other patients developed metastatic pancreatic adenocarcinoma and did not undergo resection. All 5 patients (4{\%}) with cancer had negative margins at initial operation. Sixteen of 100 patients (16{\%}) with negative margins for IPMN at the initial operation developed a new IPMN vs 6 of 30 patients (20{\%}) with margins positive for IPMN (p = ns). Five of 22 patients (23{\%}) with a new IPMN had a family history of pancreatic cancer, while 8 of 108 patients (7{\%}) without a new IPMN had a family history (p < 0.05). Overall, the chances of developing a new IPMN at 1, 5, and 10 years after the initial surgery were 4{\%}, 25{\%}, and 62{\%}, respectively, and of requiring surgery were 1.6{\%}, 14{\%}, and 18{\%}, respectively. The estimated chances of developing invasive pancreatic cancer were 0{\%}, 7{\%}, and 38{\%} at 1, 5, and 10 years, respectively. Conclusions: Patients who have undergone resection for noninvasive IPMN require indefinite close surveillance because of the risks of developing a new IPMN, of requiring surgery, and of developing cancer. A family history of pancreatic cancer, but not margin status or degree of dysplasia, is associated with a risk of development of a new or progressive IPMN.",
author = "Jin He and Cameron, {John L.} and Nita Ahuja and Makary, {Martin A.} and Kenzo Hirose and Choti, {Michael A.} and Schulick, {Richard D.} and Hruban, {Ralph H.} and Pawlik, {Timothy M.} and Wolfgang, {Christopher L.}",
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T1 - Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm?

AU - He, Jin

AU - Cameron, John L.

AU - Ahuja, Nita

AU - Makary, Martin A.

AU - Hirose, Kenzo

AU - Choti, Michael A.

AU - Schulick, Richard D.

AU - Hruban, Ralph H.

AU - Pawlik, Timothy M.

AU - Wolfgang, Christopher L.

PY - 2013/4

Y1 - 2013/4

N2 - Background: Little is known about the risk of subsequently developing a new or progressive intraductal papillary mucinous neoplasm (IPMN) after partial pancreatic resection of a noninvasive IPMN. Study Design: One hundred thirty patients with more than 1 year of follow-up after resection were included in this analysis. Results: At a median follow-up of 38 months, 22 (17%) developed imaging evidence of a new or progressive IPMN. Eleven (8%) underwent completion resection. Three of the 11 patients had invasive adenocarcinoma. Two other patients developed metastatic pancreatic adenocarcinoma and did not undergo resection. All 5 patients (4%) with cancer had negative margins at initial operation. Sixteen of 100 patients (16%) with negative margins for IPMN at the initial operation developed a new IPMN vs 6 of 30 patients (20%) with margins positive for IPMN (p = ns). Five of 22 patients (23%) with a new IPMN had a family history of pancreatic cancer, while 8 of 108 patients (7%) without a new IPMN had a family history (p < 0.05). Overall, the chances of developing a new IPMN at 1, 5, and 10 years after the initial surgery were 4%, 25%, and 62%, respectively, and of requiring surgery were 1.6%, 14%, and 18%, respectively. The estimated chances of developing invasive pancreatic cancer were 0%, 7%, and 38% at 1, 5, and 10 years, respectively. Conclusions: Patients who have undergone resection for noninvasive IPMN require indefinite close surveillance because of the risks of developing a new IPMN, of requiring surgery, and of developing cancer. A family history of pancreatic cancer, but not margin status or degree of dysplasia, is associated with a risk of development of a new or progressive IPMN.

AB - Background: Little is known about the risk of subsequently developing a new or progressive intraductal papillary mucinous neoplasm (IPMN) after partial pancreatic resection of a noninvasive IPMN. Study Design: One hundred thirty patients with more than 1 year of follow-up after resection were included in this analysis. Results: At a median follow-up of 38 months, 22 (17%) developed imaging evidence of a new or progressive IPMN. Eleven (8%) underwent completion resection. Three of the 11 patients had invasive adenocarcinoma. Two other patients developed metastatic pancreatic adenocarcinoma and did not undergo resection. All 5 patients (4%) with cancer had negative margins at initial operation. Sixteen of 100 patients (16%) with negative margins for IPMN at the initial operation developed a new IPMN vs 6 of 30 patients (20%) with margins positive for IPMN (p = ns). Five of 22 patients (23%) with a new IPMN had a family history of pancreatic cancer, while 8 of 108 patients (7%) without a new IPMN had a family history (p < 0.05). Overall, the chances of developing a new IPMN at 1, 5, and 10 years after the initial surgery were 4%, 25%, and 62%, respectively, and of requiring surgery were 1.6%, 14%, and 18%, respectively. The estimated chances of developing invasive pancreatic cancer were 0%, 7%, and 38% at 1, 5, and 10 years, respectively. Conclusions: Patients who have undergone resection for noninvasive IPMN require indefinite close surveillance because of the risks of developing a new IPMN, of requiring surgery, and of developing cancer. A family history of pancreatic cancer, but not margin status or degree of dysplasia, is associated with a risk of development of a new or progressive IPMN.

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