Risk of Recurrence After Surgical Resection for Adenocarcinoma Arising From Intraductal Papillary Mucinous Neoplasia (IPMN) With Patterns of Distribution and Treatment: An International, Multicenter, Observational Study (ADENO-IPMN Study).
Lucocq J., Hawkyard J., Robertson FP., Haugk B., Lye J., Parkinson D., White S., Mownah O., Zen Y., Menon K., Furukawa T., Inoue Y., Hirose Y., Sasahira N., Feretis M., Balakrishnan A., Zelga P., Ceresa C., Davidson B., Pande R., Dasari B., Tanno L., Karavias D., Helliwell J., Young A., Nunes Q., Urbonas T., Silva M., Gordon-Weeks A., Barrie J., Gomez D., van Laarhoven S., Doyle J., Bhogal R., Harrison E., Roalso M., Ciprani D., Aroori S., Ratnayake B., Koea J., Capurso G., Bellotti R., Stättner S., Alsaoudi T., Bhardwaj N., Jeffery F., Connor S., Cameron A., Jamieson N., Sheen A., Mittal A., Samra J., Gill A., Roberts K., Soreide K., Pandanaboyana S.
OBJECTIVE: This international multicenter cohort study aims to identify recurrence patterns and treatment of first and second recurrence in a large cohort of patients after pancreatic resection for adenocarcinoma arising from intraductal papillary mucinous neoplasm (IPMN). BACKGROUND: Recurrence patterns and treatment of recurrence postresection of adenocarcinoma arising from IPMN are poorly explored. METHODS: Patients undergoing pancreatic resection for adenocarcinoma from IPMN between January 2010 and December 2020 at 18 pancreatic centers were identified. Survival analysis was performed using the Kaplan-Meier log-rank test and multivariable logistic regression by Cox-Proportional Hazards modeling. End points were recurrence (time-to, location, and pattern of recurrence) and survival (overall survival and adjusted for treatment provided). RESULTS: Four hundred fifty-nine patients were included (median, 70 years; interquartile range, 64-76; male, 54%) with a median follow-up of 78.1 months. Recurrence occurred in 209 patients [45.5%; median time to recurrence, 12.8 months; early recurrence (within 1 years), 23.2%]. Eighty-three (18.1%) patients experienced a local regional recurrence, and 164 (35.7%) patients experienced a distant recurrence. Adjuvant chemotherapy was not associated with reduction in recurrence (hazard ratio 1.09; P =0.669) One hundred twenty patients with recurrence received further treatment. The median survival with and without additional treatment was 27.0 and 14.6 months ( P <0.001), with no significant difference between treatment modalities. There was no significant difference in survival between locations of recurrence ( P =0.401). CONCLUSIONS: Recurrence after pancreatic resection for adenocarcinoma arising from IPMN is frequent with a quarter of patients recurring within 12 months. Treatment of recurrence is associated with improved overall survival and should be considered.