• Giovanni Marchegiani, Mari Mino-Kenudson, Cristina R Ferrone, Vicente Morales-Oyarvide, Andrew L Warshaw, Keith D Lillemoe, and Carlos Fernández-Del Castillo.
• *Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA †Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
• Ann. Surg. 2015 Dec 1;262(6):1108-14.

ObjectiveTo describe the patterns of recurrence after resection of intraductal papillary mucinous neoplasms (IPMN) of the pancreas.BackgroundIPMNs represent an increasing indication for pancreatic resection, but little is known about the actual incidence and the patterns of recurrence after surgical excision.MethodsRetrospective review of 412 resected IPMNs from 1990 to 2013 who have had near-complete follow-up.ResultsMedian age of the cohort was 68 years, 56% had branch duct (BD)-IPMN and 21% had invasive cancers. Nineteen patients (5%) had distinct pancreatic ductal adenocarcinoma (PDAC) and were excluded from the recurrence analysis. After a median of 58 months, 65 of 381 patients (17%) experienced recurrence of the IPMN, and 5- and 10-year disease-free survival (DFS) was 82% and 78%, respectively. Only 2 patients (0.5%) developed metachronous PDAC. In 33 patients (9%), a residual BD-IPMN was left in the pancreatic remnant, but none of these significantly grew or required reoperation. Invasive component and resection margin positive for IPMN were predictors of recurrence (P < 0.05). Invasive IPMN recurred in 45% of cases, whereas noninvasive in only 9% and later (P < 0.001), but patterns depended on IPMN subtypes. Only 9 patients required reoperation for recurrence, with good long-term outcome particularly for oncocytic IPMNs.ConclusionsRecurrence of noninvasive BD-IPMN is infrequent and surveillance may be avoided in selected cases. In invasive IPMN recurrence depends on N status, pancreatic margin, and invasive type.

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