Long-term outcomes following resection of adenocarcinoma arising from intraductal papillary mucinous neoplasm (A-IPMN) versus pancreatic ductal adenocarcinoma (PDAC): a propensity-score matched analysis.
Abstract
Objective: The aim of the present study was to compare long-term post-resection oncological outcomes between A-IPMN and PDAC.
Summary background data: Knowledge of long term oncological outcomes (e.g recurrence and survival data) comparing between adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) and pancreatic ductal adenocarcinoma (PDAC) is scarce.
Methods: Patients undergoing pancreatic resection (2010-2020) for A-IPMN were identified retrospectively from 18 academic pancreatic centres and compared with PDAC patients from the same time-period. Propensity-score matching (PSM) was performed and survival and recurrence were compared between A-IPMN and PDAC.
Results: 459 A-IPMN patients (median age,70; M:F,250:209) were compared with 476 PDAC patients (median age,69; M:F,262:214). A-IPMN patients had lower T-stage, lymphovascular invasion (51.4%vs. 75.6%), perineural invasion (55.8%vs. 71.2%), lymph node positivity (47.3vs. 72.3%) and R1 resection (38.6%vs. 56.3%) compared to PDAC(P<0.001). The median survival and time-to-recurrence for A-IPMN versus PDAC were 39.0 versus19.5months (P<0.001) and 33.1 versus 14.8months (P<0.001), respectively (median follow-up,78 vs.73 months). Ten-year overall survival for A-IPMN was 34.6%(27/78) and PDAC was 9%(6/67). A-IPMN had higher rates of peritoneal (23.0 vs. 9.1%, P<0.001) and lung recurrence (27.8% vs. 15.6%, P<0.001) but lower rates of locoregional recurrence (39.7% vs. 57.8%; P<0.001). Matched analysis demonstrated inferior overall survival (P=0.005), inferior disease-free survival (P=0.003) and higher locoregional recurrence (P<0.001) in PDAC compared to A-IPMN but no significant difference in systemic recurrence rates (P=0.695).
Conclusions: PDACs have inferior survival and higher recurrence rates compared to A-IPMN in matched cohorts. Locoregional recurrence is higher in PDAC but systemic recurrence rates are comparable and constituted by their own distinctive site-specific recurrence patterns.
Author
Lucocq, James
Halle-Smith, James
Haugk, Beate
Joseph, Nejo
Hawkyard, Jake
Lye, Jonathan
Parkinson, Daniel
White, Steve
Mownah, Omar
Zen, Yoh
Menon, Krishna
Furukawa, Takaki
Inoue, Yosuke
Hirose, Yuki
Sasahira, Naoki
Mittal, Anubhav
Samra, Jas
Sheen, Amy
Feretis, Michael
Balakrishnan, Anita
Ceresa, Carlo
Davidson, Brian
Pande, Rupaly
Dasari, Bobby V M
Tanno, Lulu
Karavias, Dimitrios
Helliwell, Jack
Young, Alistair
Marks, Kate
Nunes, Quentin
Urbonas, Tomas
Silva, Michael
Gordon-Weeks, Alex
Barrie, Jenifer
Gomez, Dhanny
van Laarhoven, Stijn
Nawara, Hossam
Doyle, Joseph
Bhogal, Ricky
Harrison, Ewen
Roalso, Marcus
Ciprani, Debora
Aroori, Somaiah
Ratnayake, Bathiya
Koea, Jonathan
Capurso, Gabriele
Bellotti, Ruben
Stättner, Stefan
Alsaoudi, Tareq
Bhardwaj, Neil
Rajesh, Srujan
Jeffery, Fraser
Connor, Saxon
Cameron, Andrew
Jamieson, Nigel
Soreide, Kjetil
Gill, Anthony J
Roberts, Keith
Pandanaboyana, Sanjay
Halle-Smith, James
Haugk, Beate
Joseph, Nejo
Hawkyard, Jake
Lye, Jonathan
Parkinson, Daniel
White, Steve
Mownah, Omar
Zen, Yoh
Menon, Krishna
Furukawa, Takaki
Inoue, Yosuke
Hirose, Yuki
Sasahira, Naoki
Mittal, Anubhav
Samra, Jas
Sheen, Amy
Feretis, Michael
Balakrishnan, Anita
Ceresa, Carlo
Davidson, Brian
Pande, Rupaly
Dasari, Bobby V M
Tanno, Lulu
Karavias, Dimitrios
Helliwell, Jack
Young, Alistair
Marks, Kate
Nunes, Quentin
Urbonas, Tomas
Silva, Michael
Gordon-Weeks, Alex
Barrie, Jenifer
Gomez, Dhanny
van Laarhoven, Stijn
Nawara, Hossam
Doyle, Joseph
Bhogal, Ricky
Harrison, Ewen
Roalso, Marcus
Ciprani, Debora
Aroori, Somaiah
Ratnayake, Bathiya
Koea, Jonathan
Capurso, Gabriele
Bellotti, Ruben
Stättner, Stefan
Alsaoudi, Tareq
Bhardwaj, Neil
Rajesh, Srujan
Jeffery, Fraser
Connor, Saxon
Cameron, Andrew
Jamieson, Nigel
Soreide, Kjetil
Gill, Anthony J
Roberts, Keith
Pandanaboyana, Sanjay
Citations
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Date
2024-03-22
Type
Article
Subject
Gastroenterology, Surgery
Collections
Citation
Lucocq J, Halle-Smith J, Haugk B, Joseph N, Hawkyard J, Lye J, Parkinson D, White S, Mownah O, Zen Y, Menon K, Furukawa T, Inoue Y, Hirose Y, Sasahira N, Mittal A, Samra J, Sheen A, Feretis M, Balakrishnan A, Ceresa C, Davidson B, Pande R, Dasari BVM, Tanno L, Karavias D, Helliwell J, Young A, Marks K, Nunes Q, Urbonas T, Silva M, Gordon-Weeks A, Barrie J, Gomez D, van Laarhoven S, Nawara H, 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, Rajesh S, Jeffery F, Connor S, Cameron A, Jamieson N, Soreide K, Gill AJ, Roberts K, Pandanaboyana S. Long-term Outcomes Following Resection of Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasm (A-IPMN) Versus Pancreatic Ductal Adenocarcinoma (PDAC): A Propensity-score Matched Analysis. Ann Surg. 2025 Dec 1;282(6):1034-1044. doi: 10.1097/SLA.0000000000006272. Epub 2024 Mar 22.
Journal / Source Title
Annals of Surgery
DOI
10.1097/SLA.0000000000006272
PMID
38516777
Publisher
Lippincott, Williams & Wilkins
Publisher’s URL
https://www.ncbi.nlm.nih.gov/pmc/journals/230/