• Thomas Schnelldorfer, Michael G Sarr, David M Nagorney, Lizhi Zhang, Thomas C Smyrk, Rui Qin, Suresh T Chari, and Michael B Farnell.
• Division of Gastroenterologic and General Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
• Arch Surg. 2008 Jul 1;143(7):639-46; discussion 646.

HypothesisIntraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized disease of the pancreas. We report our experience with pancreatic resection for IPMN.DesignRetrospective review from 1992 through 2005 with additional independent histopathologic confirmation.SettingMayo Clinic Rochester, a tertiary care center.PatientsAll patients who underwent primary resection for pancreatic IPMN.Main Outcome MeasuresDisease-specific operative outcomes, survival, and recurrence patterns.ResultsOf 208 patients (mean age, 66 years) with IPMN of the pancreas, 168 underwent partial pancreatectomy, and 40 underwent total pancreatectomy; 88 were classified as having adenoma, 38 as having borderline neoplasm, 19 as having carcinoma in situ, and 63 as having invasive carcinoma. The prevalence of a malignant neoplasm was 64% in patients with main duct IPMN compared with 18% in patients with branch duct IPMN. Re-resection of the initial pancreatic margin was necessary in 21% of patients. Final negative margins were achieved in 89% of patients. Five-year survival with noninvasive IPMN was 94%. Patients with invasive IPMN had a similar 5-year survival compared with a matched cohort with ductal adenocarcinoma (31% vs 24%; P = .26). In patients with invasive IPMN, 58% experienced disease recurrence. In patients with noninvasive IPMN, 10% experienced disease recurrence after partial pancreatectomy and 0% experienced disease recurrence after total pancreatectomy.ConclusionsPatients with main duct IPMN or high-risk branch duct IPMN should be considered for targeted pancreatectomy. Invasive IPMN behaves as aggressively as ductal adenocarcinoma, but resection seems to provide the only potential for cure. Even with negative resection margins, the pancreatic remnant harbors a risk of recurrence and, thus, careful long-term surveillance is warranted.

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