• Annals of surgery · Sep 2024

    Total versus Partial Pancreatectomy in Patients with Pancreatic Cancer Arising from Multifocal or Diffuse Intraductal Papillary Mucinous Neoplasia - A Multicenter Observational Study.

    • Ingmar F Rompen, Joseph R Habib, Benedict Kinny-Köster, Brady A Campbell, Thomas F Stoop, Christoph Kümmerli, Paul C M Andel, Charlotte A Leseman, Carolin Lesch, Lois A Daamen, Ammar A Javed, Kelly J Lafaro, Henrik Nienhüser, Adrian T Billeter, I Quintus Molenaar, Beat P Müller-Stich, Marc G Besselink, Jin He, Martin Loos, Markus W Büchler, and Christopher L Wolfgang.
    • New York University Langone Health, Department of Surgery, New York, USA.
    • Ann. Surg. 2024 Sep 18.

    AimTo investigate the impact of total pancreatectomy (TP) on oncological outcomes for patients at high-risk of local recurrence or secondary progression in the remnant gland after partial pancreatectomy (PP) for IPMN-associated cancer.Summary Background DataMajor risk factors for invasive progression in the remnant gland include multifocality, diffuse main duct dilation, and the presence of invasive cancer. In these high-risk patients, a TP may be oncologically beneficial. However, current guidelines discourage TP, especially in elderly patients.MethodsThis international multicenter study compares TP versus PP in patients with adenocarcinoma arising from multifocal or diffuse IPMN (2002-2022). Log-rank test and multivariable Cox-analysis with interaction analysis was performed to assess overall survival (OS), disease-free survival (DFS), and local-DFS.ResultsOf 359 included patients, 162 (45%) were treated with TP, whereas 197 (55%) underwent PP. Despite TP and PP having similar R0-rates (59% vs. 58%, P=0.866), patients undergoing a TP had significantly longer local-DFS compared to PP (P=0.039). However, no difference in OS was observed between the two surgical approaches (P=0.487). In a multivariable analysis, young age (optimal cut-off ≤63.6 yrs) was associated with an OS benefit derived from TP (HR:0.44, 95%CI:0.22-0.89), whereas no significant difference was observed in elderly patients (HR:1.24, 95%CI:0.92-1.67, Pinteraction=0.007).ConclusionSince overall, patients with diffuse or multifocal IPMN with an invasive component do not benefit from TP in terms of OS, the indication for TP may be individualized to young patients who have sufficient life expectancy to benefit from the prevention of secondary progression or local recurrence.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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