Long-term survival after resection of invasive pancreatic intraductal papillary mucinous neoplasm

This study aimed to report the long-term outcomes after surgical resection for invasive (I) intraductal papillary mucinous neoplasm (IPMN) and to define prognostic factors for survival.

We retrospectively evaluated all consecutive pancreatic resections performed IPMN between January 1, 2007, and December 31, 2022. Multivariate Cox analysis identified risk factors for survival.

Surgery for IPMN was performed in 125 patients including 78 I-IPMN (62%). Ninety-day mortality rates was 1.6% (n = 2) with an overall morbidity rate of 44.4%. I-IPMN showed higher serum CA 19 − 9 serum values (p < 0.0001), more frequently jaundice (p = 0.008), more high-risk stigmata (p = 0.002) and diffuse IPMN form (p = 0.005) compared with non-invasive IPMN. The median overall survival for I-IPMN was 178.36 months (95% confidence interval [CI]: 87.01–NR) with overall survival rates at one, three, five, and 10 years of 91%, 75%, 72%, and 62%, respectively. Jaundice (hazard ratio [HR]: 4.23; 95% CI: 1.48–12.07; p = 0.006), T3 lesions (HR: 3.24; 95% CI: 1.65–6.39; p = 0.006), absence of lymph node involvement (HR: 0.15; 95% CI: 0.04–0.60; p = 0.0007), R1 margin status (HR: 2.96;95%CI:1.08-8:15;p = 0.03) and need for venous resection (HR: 4.30; 95% CI: 1.26–14.6; p = 0.006) were identified as independent risk factors for survival.

Long-term survival and cure can be observed after surgical resection of pancreatic adenocarcinomas originating from I-IPMN when resected at early stage (Tis, T1, T2). I-IPMN spreading beyond pancreatic ducts (jaundice, T3 lesions, lymph nodes, Veins) have limited long-term survival.