• Michael J Pflüger, James F Griffin, Wenzel M Hackeng, Satomi Kawamoto, Jun Yu, Peter Chianchiano, Eunice Shin, Gemma Lionheart, Hua-Ling Tsai, Hao Wang, Neda Rezaee, Richard A Burkhart, John L Cameron, Elizabeth D Thompson, Christopher L Wolfgang, Jin He, BrosensLodewijk A ALAADepartment of Pathology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD.Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, The Nethe, and Laura D Wood.
• Department of Pathology, the Sol Goldman Pancreatic Cancer Research Center, Johns Hopkins University School of Medicine, Baltimore, MD.
• Ann. Surg. 2022 Jun 1; 275 (6): 116511741165-1174.

ObjectiveThis study aimed to identify risk factors for recurrence after pancreatic resection for intraductal papillary mucinous neoplasm (IPMN).Summary Background DataLong-term follow-up data on recurrence after surgical resection for IPMN are currently lacking. Previous studies have presented mixed results on the role of margin status in risk of recurrence after surgical resection.MethodsA total of 126 patients that underwent resection for noninvasive IPMN were followed for a median of 9.5 years. Dedicated pathological and radiological reviews were performed to correlate clinical and pathological features (including detailed pathological features of the parenchymal margin) with recurrence after surgical resection. In addition, in a subset of 32 patients with positive margins, we determined the relationship between the margin and original IPMN using driver gene mutations identified by next-generation sequencing.ResultsFamily history of pancreatic cancer and high-grade IPMN was identified as risk factors for recurrence in both uni- and multivariate analysis (adjusted hazard ratio 3.05 and 1.88, respectively). Although positive margin was not significantly associated with recurrence in our cohort, the size and grade of the dysplastic focus at the margin were significantly correlated with recurrence in margin-positive patients. Genetic analyses showed that the neoplastic epithelium at the margin was independent from the original IPMN in at least 9 of 32 cases (28%). The majority of recurrences (74%) occurred after 3 years, and a significant minority (32%) occurred after 5 years.ConclusionSustained postoperative surveillance for all patients is indicated, particularly those with risk factors such has family history and high-grade dysplasia.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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