Elsevier

Surgery

Volume 157, Issue 3, March 2015, Pages 473-483
Surgery

Liver/Pancreas
Noninvasive intraductal papillary mucinous neoplasms and mucinous cystic neoplasms: Recurrence rates and postoperative imaging follow-up

Portions of this manuscript were presented at the Massachusetts Chapter of the American College of Surgeons, Boston, MA, December 2011; Academic Surgical Congress, Las Vegas, NV, February 2012; and The Pancreas Club, San Diego, CA, May 2012.
https://doi.org/10.1016/j.surg.2014.09.028Get rights and content

Background

Although surveillance guidelines for resected invasive mucinous neoplastic cysts are well-established, those for noninvasive cysts are not defined. We used our experience with resected noninvasive mucinous neoplastic cysts to define recurrence rates and the optimal frequency of postoperative imaging follow-up.

Methods

We reviewed the medical records of 134 patients with resected, pathologically confirmed noninvasive mucinous neoplasms between 2002 and 2012. Demographics, comorbidities, cyst characteristics, and recurrence were evaluated. Survival analysis was used to estimate the distribution of time to recurrence and regression models were used to investigate factors associated with recurrence.

Results

Eighty-seven patients with intraductal papillary mucinous neoplasms (IPMNs) were compared with 47 patients with mucinous cystic neoplasms (MCNs). Those with MCNs were more often females (P = .001), significantly younger (P = .001), more symptomatic (P = .009), and had cysts more often located in the tail (P < .001). Median follow-up was 42 months. Recurrence rates for IPMNs were 0%, 5%, and 10% versus 0% for MCNs respectively at postoperative years 1, 2, and 3 (P = .014). On multivariable analysis, size >3 cm (P = .027), higher grade dysplasia (P = .043), and positive resection margins (P < .001) were significantly associated with recurrence.

Conclusion

Resected noninvasive IPMNs with moderate- or high-grade dysplasia and negative resection margins require imaging follow-up every 2 years, given the 16% overall recurrence rate. Although the follow-up interval for noninvasive, low-grade, dysplastic IPMNs with negative margins could be lengthened, all noninvasive IPMNs having positive margins require yearly follow-up at the minimum. Resected noninvasive MCNs––irrespective of grade and margin status––do not require surveillance, although the development of branch duct-IPMNs in the remnant pancreas can be investigated in the long term at the discretion of the provider.

Section snippets

Methods

The study was approved by the Institutional Review Board of the Brigham and Women's Hospital. International Classification of Disease-9 codes for pancreatic cysts or benign neoplasms of the pancreas were identified from the Research Patient Data Registry. Patients with surgically resected, pathologically confirmed pancreatic cysts between July 2002 and 2012 were identified. After initial review of the medical records, we included pathologically confirmed MD-IPMNs, BD-IPMNs, and MCNs, excluding

Results

We analyzed data from 134 patients with confirmed noninvasive mucinous neoplastic cysts. We had 47 patients with MCNs (35%) and 87 with IPMNs (65%). Of the 87 IPMNs, 36 were MD-IPMNs (41%) and 51 were BD-IPMN (59%). Of the 134 resected neoplasms, 59 had low-grade dysplasia (44%), 54 had moderate-grade dysplasia (40%), and 21 had high-grade dysplasia (16%).

Discussion

In this study, we analyze the demographic and clinicopathologic features of surgically resected noninvasive IPMNs and MCNs, emphasizing recurrence rates, frequency of imaging follow-up, and whether this follow-up is justifiable and cost effective. The decision to follow-up a resected noninvasive mucinous pancreatic neoplastic cyst is primarily a matter of clinical judgment based on the risk of recurrence as well as perceived pancreatic cancer risk.

The distinction between IPMNs and MCNs was not

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