Hepato-Biliary and Pancreatic Surgery Unit, Edouard Herriot Hospital-HCL, Lyon, France.
Pancreas. 2012 Jan;41(1):137-41. doi: 10.1097/MPA.0b013e318222bc9c.
The detection of intraductal papillary mucinous neoplasms (IPMN) has increased over the last decade, but still, management remains controversial. The main problems are their potential for malignancy and risk of recurrence. The purpose of this study was to determine the predictive factors of recurrence after surgical resection.
All patients with IPMN who underwent pancreatectomy with curative intent were considered. Data were collected from a prospective base.
From 1994 to 2009, 104 patients underwent pancreatectomy. Twenty-one (20%) had recurrence, 15 on remnant pancreas (none on pancreatic cut surface) and 6 with distant metastases. Twelve patients had total pancreatectomy (1 awaiting surgery). Thirteen (38.2%) of 34 patients with invasive IPMN and 20 (25.9%) of 77 with main duct involvement (including combined type) had recurrence. In univariate analysis, American Society of Anesthesiologist score and histological and duct type had a significant impact on recurrence rate. In multivariate analysis, histological type (invasiveness) was the only significant predictive factor for recurrence.
The risk of recurrence of IPMN after resection depends on the histological type. According to surgical margin, invasiveness, and the type of duct involved, we identified a high-risk group with invasive main duct lesion and a low-risk group with noninvasive branch duct lesion.
在过去的十年中，人们对胰管内乳头状黏液性肿瘤（IPMN）的检出率有所增加，但治疗方法仍存在争议。主要问题是其恶性潜能和复发风险。本研究旨在确定手术切除后复发的预测因素。
所有接受根治性胰切除术的 IPMN 患者均被纳入研究。数据来自一个前瞻性数据库。
1994 年至 2009 年，104 例患者接受了胰切除术。21 例（20%）患者出现复发，其中 15 例在残胰（胰腺切面上无），6 例发生远处转移。12 例患者行全胰切除术（1 例等待手术）。34 例侵袭性 IPMN 患者中有 13 例（38.2%）和 77 例主胰管受累（包括混合型）患者中有 20 例（25.9%）出现复发。单因素分析显示，美国麻醉医师协会评分、组织学和胰管类型对复发率有显著影响。多因素分析显示，组织学类型（侵袭性）是复发的唯一显著预测因素。
切除后 IPMN 的复发风险取决于组织学类型。根据手术切缘、侵袭性和受累胰管类型，我们确定了一个高危组，即具有侵袭性主胰管病变，和一个低危组，即具有非侵袭性分支胰管病变。
