• James Lucocq, James Halle-Smith, Beate Haugk, Nejo Joseph, Jake Hawkyard, Jonathan Lye, Daniel Parkinson, Steve White, Omar Mownah, Yoh Zen, Krishna Menon, Takaki Furukawa, Yosuke Inoue, Yuki Hirose, Naoki Sasahira, Anubhav Mittal, Jas Samra, Amy Sheen, Michael Feretis, Anita Balakrishnan, Carlo Ceresa, Brian Davidson, Rupaly Pande, DasariBobby V MBVMHepatobiliary and Pancreatic Surgery Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, UK., Lulu Tanno, Dimitrios Karavias, Jack Helliwell, Alistair Young, Kate Marks, Quentin Nunes, Tomas Urbonas, Michael Silva, Alex Gordon-Weeks, Jenifer Barrie, Dhanny Gomez, Stijn van Laarhoven, Hossam Nawara, Joseph Doyle, Ricky Bhogal, Ewen Harrison, Marcus Roalso, Debora Ciprani, Somaiah Aroori, Bathiya Ratnayake, Jonathan Koea, Gabriele Capurso, Ruben Bellotti, Stefan Stättner, Tareq Alsaoudi, Neil Bhardwaj, Srujan Rajesh, Fraser Jeffery, Saxon Connor, Andrew Cameron, Nigel Jamieson, Kjetil Soreide, Anthony J Gill, Keith Roberts, and Sanjay Pandanaboyana.
• Department of General Surgery, NHS Lothian, UK.
• Ann. Surg. 2024 Mar 22.

ObjectiveThe aim of the present study was to compare long-term post-resection oncological outcomes between A-IPMN and PDAC.Summary Background DataKnowledge of long term oncological outcomes (e.g recurrence and survival data) comparing between adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) and pancreatic ductal adenocarcinoma (PDAC) is scarce.MethodsPatients undergoing pancreatic resection (2010-2020) for A-IPMN were identified retrospectively from 18 academic pancreatic centres and compared with PDAC patients from the same time-period. Propensity-score matching (PSM) was performed and survival and recurrence were compared between A-IPMN and PDAC.Results459 A-IPMN patients (median age,70; M:F,250:209) were compared with 476 PDAC patients (median age,69; M:F,262:214). A-IPMN patients had lower T-stage, lymphovascular invasion (51.4%vs. 75.6%), perineural invasion (55.8%vs. 71.2%), lymph node positivity (47.3vs. 72.3%) and R1 resection (38.6%vs. 56.3%) compared to PDAC(P<0.001). The median survival and time-to-recurrence for A-IPMN versus PDAC were 39.0 versus19.5months (P<0.001) and 33.1 versus 14.8months (P<0.001), respectively (median follow-up,78 vs.73 months). Ten-year overall survival for A-IPMN was 34.6%(27/78) and PDAC was 9%(6/67). A-IPMN had higher rates of peritoneal (23.0 vs. 9.1%, P<0.001) and lung recurrence (27.8% vs. 15.6%, P<0.001) but lower rates of locoregional recurrence (39.7% vs. 57.8%; P<0.001). Matched analysis demonstrated inferior overall survival (P=0.005), inferior disease-free survival (P=0.003) and higher locoregional recurrence (P<0.001) in PDAC compared to A-IPMN but no significant difference in systemic recurrence rates (P=0.695).ConclusionsPDACs have inferior survival and higher recurrence rates compared to A-IPMN in matched cohorts. Locoregional recurrence is higher in PDAC but systemic recurrence rates are comparable and constituted by their own distinctive site-specific recurrence patterns.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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