Elsevier

Pancreatology

Volume 23, Issue 1, January 2023, Pages 90-97
Pancreatology

Outcome after surgery for invasive intraductal papillary mucinous neoplasia compared to conventional pancreatic ductal adenocarcinoma – A Swedish nationwide register-based study

https://doi.org/10.1016/j.pan.2022.12.003Get rights and content
Under a Creative Commons license
open access

Highlights

  • Unsettled long-term prognosis of inv-IPMN compared to PDAC.

  • National registry-based study over ten years and nearly 2000 patients.

  • Inv-IPMN more indolent in early stages and more aggressive in late stages.

Abstract

Background

The clinical importance of intraductal papillary mucinous neoplasm (IPMN) have increased last decades. Long-term survival after resection for invasive IPMN (inv-IPMN) compared to conventional pancreatic ductal adenocarcinoma (PDAC) is not thoroughly delineated.

Objective

This study, based on the Swedish national pancreatic and periampullary cancer registry aims to elucidate the outcome after resection of inv-IPMN compared to PDAC.

Methods

All patients ≥18 years of age resected for inv-IPMN and PDAC in Sweden between 2010 and 2019 were included. Clinicopathological variables were retrieved from the national registry. The effect on death was assessed in two multivariable Cox regression models, one for patients resected 2010–2015, one for patients resected 2016–2019. Median overall survival (OS) was estimated using the Kaplan-Meier method.

Results

We included 1909 patients, 293 inv-IPMN and 1616 PDAC. The most important independent predictors of death in multivariable Cox regressions were CA19-9 levels, venous resection, tumour differentiation, as well as T-, N-, M-stage and surgical margin. Tumour type was an independent predictor for death in the 2016–2019 cohort, but not in the 2010–2015 cohort. In Kaplan-Meier survival analysis, inv-IPMN was associated with longer median OS in stage N0-1 and in stage M0 compared to PDAC. However, in stage T2-4 and stage N2 median OS was similar, and in stage M1 even shorter for inv-IPMN compared to PDAC.

Conclusion

In this population-based nationwide study, outcome after resected inv-IPMN compared to PDAC is more favourable in lower stages, and similar to worse in higher.

Keywords

Intraductal papillary mucinous neoplasm
Invasive
Pancreatic ductal adenocarcinoma
Outcome
Survival

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