Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas

OBJECTIVE: Treatment of intraductal papillary and mucinous tumors of pancre as (IPMT) usually requires surgery. The objective of this study was to eval uate the risk of recurrence in patients after surgery according to the hist ological nature of the neoplasm and the type of surgery. METHODS: The outcome of 45 patients who underwent partial pancreatectomy (n = 35) or total pancreatectomy (n = 10) for IPMT was studied according to t he nature of the neoplasm (invasive carcinoma or noninvasive neoplasm), typ e of surgery (partial or total pancreatectomy), and lymph nodes status. RESULTS: The overall 3-yr actuarial survival rate was 83%. Death occurred i n seven of 20 (35%) patients with invasive carcinoma and in one of 26 (4%) patients with noninvasive tumors (p < 0.05). There were two recurrences in the seven patients with noninvasive neoplasm who underwent partial pancreat ectomy with involved resection margins, and none in the 13 patients with di sease-free margins. In patients with invasive carcinoma, there was one recu rrence after total pancreatectomy, six after partial pancreatectomy with di sease-free margins and six after partial pancreatectomy with involved margi ns. In patients with invasive carcinoma, total pancreatectomy and the absen ce of lymph nodes involvement were independently associated with a low risk of recurrence. CONCLUSIONS: IPMT may be managed as follows: 1) in patients with noninvasiv e neoplasms, partial pancreatic resection should be guided by frozen sectio n examination until disease-free margins are obtained; and 2) in patients w ith invasive carcinoma, total pancreatectomy seems most likely to cure the patient, but should be discussed according to the general status and the ag e. (C) 2000 by Am. Cell. of Gastroenterology.