Long-term surveillance is necessary after operative resection for intraductal papillary mucinous neoplasm of the pancreas

Abstract

Background: There is not enough evidence to establish an appropriate surveillance strategy after operative resection for intraductal papillary mucinous neoplasm.

Methods: This study included 257 consecutive intraductal papillary mucinous neoplasm patients who underwent operative resection between July 1999 and March 2014. The frequencies, patterns, time-to-event, and risk factors for postoperative recurrence in intraductal papillary mucinous neoplasm were analyzed.

Results: Fifty-six intraductal papillary mucinous neoplasm patients (21.8%) had recurrence after the operation, including those with remnant pancreatic recurrence (n = 14) and extrapancreatic recurrence (n = 42). Remnant pancreatic recurrence had no influence on the overall survival, whereas patients with extrapancreatic recurrence had significantly worse overall survival (P < .001). Furthermore, the overall survival of intraductal papillary mucinous neoplasm patients with extrapancreatic recurrence was shorter than that for patients with remnant pancreatic recurrence (median overall survival: 21.8 versus 110.6 months; P < .001). Five patients experienced remnant pancreatic recurrence >5 years after the operation. All extrapancreatic recurrences occurred within 5 years. We found that the positive pancreatic transection margin was the only independent risk factor for remnant pancreatic recurrence (P < .001), whereas the risk factors for extrapancreatic recurrence were invasive intraductal papillary mucinous neoplasm (P < .001), mixed-type (P = .008), elevated serum CA19-9 (P = .019), and intraoperative transfusion (P = .025) in the multivariate analysis.

Conclusion: Our data suggest that all intraductal papillary mucinous neoplasm patients should be subject to continual surveillance every 6 months for >5 years after operation to evaluate the remnant pancreatic recurrence; furthermore, the data indicate that strict 5-year surveillance, including every 3 months for 1 year after the operation and every 6 months thereafter, is necessary for intraductal papillary mucinous neoplasm patients at risk for extrapancreatic recurrence.