Serini P, et al. Recurrence Rate According to the Resection Pancreatic Margin Hystology in Intraductal Papillary Mucinous Neoplasm of the Pancreas. JOP. J Pancreas (Online) 2005; 6(5 Suppl):509. [Abstract]

AISP - 29^th National Congress. Bologna (Italy). September 15-17, 2005

JOP. J Pancreas (Online) 2004; 6(5 Suppl):509.

Recurrence Rate According to the Resection Pancreatic Margin Hystology in Intraductal Papillary Mucinous Neoplasm of the Pancreas

Serini P, Salvia R, Mascetta G, Landoni L, Valli L, Giardino A, Pederzoli P

Department of Surgery and Gastroenterology, University of Verona. Verona, Italy

ABSTRACT

Background Intraductal papillary mucinous neoplasms of the pancreas (IPMNs) which include different biological grade of dysplasia such as adenoma (IPMA), borderline (IPMB) and carcinoma (in situ, IPMCis, or invasive, IPMC), tend to growth along the ductal tree and often are multifocal. A complete surgical resection it is not always achievable, but with total pancreatectomy (TP).

Aim of this study was to retrospectively evaluate eventual local recurrences according to final diagnosis and pancreatic margin histology in patients who underwent a partial pancreatectomy for IPMN in our Institution.

Results From 1990 to 2004, 113 patients with IPMNs underwent a pancreatic resection for the disease. The Table shows resection margin histology according to the final specimen pathological assessment.

Specimen	Resection margin (n=118)
Specimen	Negative	Adenoma	Borderline	Carcinoma	Denudation
IPMA	21	4	0	0	1
IPMB	26	7	3	0	1
IPMCis	6	2	3	0	2
IPMC	21	4	7	3	7
Total	74 (63%)	17 (14%)	13 (11%)	3 (2%)	11 (10%)

After a median follow up of 40.6 months (range 6-67 months), 6 patients (18.8%) developed a recurrence. The primary histology was an IPMC and an IPMA, in 5 cases and 1 case, respectively. The previous pancreatic margin showed a denudation in 2 cases, borderline dysplasia in other 2, it was negative in 1 and positive for carcinoma in an other patient who refused TP. The time to recurrence was 40.6 months in mean (range 6-67 months) and in 4 patients a second resection was possible.

Conclusions The results of this study confirm a low percentage of local recurrence after pancreatic resection for IPMNs which occurred both in case of negative margin and after border line dysplasia and denudation in 1.4%, 15.4%, 18.2% respectively. Moreover it is difficult to assess whether local recurrence depends on the margin status or is an expression of multifocality of the disease. Denudation seems to be particularly at risk, even if follow up is always mandatory.

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