Does Surgical Margin Impact Recurrence in Noninvasive Intraductal Papillary Mucinous Neoplasms? A Multi-institutional Study

Vikrom K. Dhar, Nipun B. Merchant, Sameer H. Patel, Michael J. Edwards, Koffi Wima, Joseph Imbus, Daniel E. Abbott, Sharon M. Weber, Raphael Louie, Hong J. Kim, Robert C.G. Martin, Charles R. Scoggins, David J. Bentrem, Michael T. LeCompte, Kamran Idrees, Alexandra G. Lopez-Aguiar, Shishir K. Maithel, David A. Kooby, Daniel A. Franco, Danny YakoubSyed A. Ahmad

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

OBJECTIVE: The relevance of margin positivity on recurrence after resection of intraductal papillary mucinous neoplasms (IPMNs) is poorly defined and represents one reason controversy remains regarding optimal surveillance recommendations. METHODS: Patients undergoing surgery for noninvasive IPMN at 8 academic medical centers from the Central Pancreas Consortium were analyzed. A positive margin was defined as presence of IPMN or pancreatic intraepithelial neoplasia. RESULTS: Five hundred two patients underwent surgery for IPMN; 330 (66%) did not have invasive cancer on final pathology and form the study cohort. Of these, 20% harbored high grade dysplasia. A positive margin was found in 20% of cases and was associated with multifocal disease (P = 0.02). The majority of positive margins were associated with low grade dysplasia. At a median follow-up of 36 months, 34 (10.3%) patients recurred, with 6.7% developing recurrent cystic disease and 3.6% developing invasive cancer. On multivariate analysis, margin positivity was not associated with recurrence of either IPMN or invasive cancer (P > 0.05). No association between margin status and development of recurrence at the margin was found. Only 6% of recurrences developed at the resection margin and median time to recurrence was 22 months. Of note, 18% of recurrences occurred > 5 years following surgery. CONCLUSION: Margin positivity after resection for noninvasive IPMNs is primarily due to low grade dysplasia and is not associated with developing recurrence in the remnant pancreas or at the resection margin. Long-term surveillance is required for all patients, as a significant number of recurrences developed over 5 years after the index operation.

Original languageEnglish (US)
Pages (from-to)469-478
Number of pages10
JournalAnnals of surgery
Volume268
Issue number3
DOIs
StatePublished - Sep 1 2018

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Recurrence
Neoplasms
Pancreas
Margins of Excision
Pancreatic Neoplasms
Cohort Studies
Multivariate Analysis
Pathology

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Dhar, V. K., Merchant, N. B., Patel, S. H., Edwards, M. J., Wima, K., Imbus, J., ... Ahmad, S. A. (2018). Does Surgical Margin Impact Recurrence in Noninvasive Intraductal Papillary Mucinous Neoplasms? A Multi-institutional Study. Annals of surgery, 268(3), 469-478. https://doi.org/10.1097/SLA.0000000000002923

Does Surgical Margin Impact Recurrence in Noninvasive Intraductal Papillary Mucinous Neoplasms? A Multi-institutional Study. / Dhar, Vikrom K.; Merchant, Nipun B.; Patel, Sameer H.; Edwards, Michael J.; Wima, Koffi; Imbus, Joseph; Abbott, Daniel E.; Weber, Sharon M.; Louie, Raphael; Kim, Hong J.; Martin, Robert C.G.; Scoggins, Charles R.; Bentrem, David J.; LeCompte, Michael T.; Idrees, Kamran; Lopez-Aguiar, Alexandra G.; Maithel, Shishir K.; Kooby, David A.; Franco, Daniel A.; Yakoub, Danny; Ahmad, Syed A.

In: Annals of surgery, Vol. 268, No. 3, 01.09.2018, p. 469-478.

Research output: Contribution to journalArticle

Dhar, VK, Merchant, NB, Patel, SH, Edwards, MJ, Wima, K, Imbus, J, Abbott, DE, Weber, SM, Louie, R, Kim, HJ, Martin, RCG, Scoggins, CR, Bentrem, DJ, LeCompte, MT, Idrees, K, Lopez-Aguiar, AG, Maithel, SK, Kooby, DA, Franco, DA, Yakoub, D & Ahmad, SA 2018, 'Does Surgical Margin Impact Recurrence in Noninvasive Intraductal Papillary Mucinous Neoplasms? A Multi-institutional Study', Annals of surgery, vol. 268, no. 3, pp. 469-478. https://doi.org/10.1097/SLA.0000000000002923
Dhar, Vikrom K. ; Merchant, Nipun B. ; Patel, Sameer H. ; Edwards, Michael J. ; Wima, Koffi ; Imbus, Joseph ; Abbott, Daniel E. ; Weber, Sharon M. ; Louie, Raphael ; Kim, Hong J. ; Martin, Robert C.G. ; Scoggins, Charles R. ; Bentrem, David J. ; LeCompte, Michael T. ; Idrees, Kamran ; Lopez-Aguiar, Alexandra G. ; Maithel, Shishir K. ; Kooby, David A. ; Franco, Daniel A. ; Yakoub, Danny ; Ahmad, Syed A. / Does Surgical Margin Impact Recurrence in Noninvasive Intraductal Papillary Mucinous Neoplasms? A Multi-institutional Study. In: Annals of surgery. 2018 ; Vol. 268, No. 3. pp. 469-478.
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abstract = "OBJECTIVE: The relevance of margin positivity on recurrence after resection of intraductal papillary mucinous neoplasms (IPMNs) is poorly defined and represents one reason controversy remains regarding optimal surveillance recommendations. METHODS: Patients undergoing surgery for noninvasive IPMN at 8 academic medical centers from the Central Pancreas Consortium were analyzed. A positive margin was defined as presence of IPMN or pancreatic intraepithelial neoplasia. RESULTS: Five hundred two patients underwent surgery for IPMN; 330 (66{\%}) did not have invasive cancer on final pathology and form the study cohort. Of these, 20{\%} harbored high grade dysplasia. A positive margin was found in 20{\%} of cases and was associated with multifocal disease (P = 0.02). The majority of positive margins were associated with low grade dysplasia. At a median follow-up of 36 months, 34 (10.3{\%}) patients recurred, with 6.7{\%} developing recurrent cystic disease and 3.6{\%} developing invasive cancer. On multivariate analysis, margin positivity was not associated with recurrence of either IPMN or invasive cancer (P > 0.05). No association between margin status and development of recurrence at the margin was found. Only 6{\%} of recurrences developed at the resection margin and median time to recurrence was 22 months. Of note, 18{\%} of recurrences occurred > 5 years following surgery. CONCLUSION: Margin positivity after resection for noninvasive IPMNs is primarily due to low grade dysplasia and is not associated with developing recurrence in the remnant pancreas or at the resection margin. Long-term surveillance is required for all patients, as a significant number of recurrences developed over 5 years after the index operation.",
author = "Dhar, {Vikrom K.} and Merchant, {Nipun B.} and Patel, {Sameer H.} and Edwards, {Michael J.} and Koffi Wima and Joseph Imbus and Abbott, {Daniel E.} and Weber, {Sharon M.} and Raphael Louie and Kim, {Hong J.} and Martin, {Robert C.G.} and Scoggins, {Charles R.} and Bentrem, {David J.} and LeCompte, {Michael T.} and Kamran Idrees and Lopez-Aguiar, {Alexandra G.} and Maithel, {Shishir K.} and Kooby, {David A.} and Franco, {Daniel A.} and Danny Yakoub and Ahmad, {Syed A.}",
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T1 - Does Surgical Margin Impact Recurrence in Noninvasive Intraductal Papillary Mucinous Neoplasms?

T2 - A Multi-institutional Study

AU - Dhar, Vikrom K.

AU - Merchant, Nipun B.

AU - Patel, Sameer H.

AU - Edwards, Michael J.

AU - Wima, Koffi

AU - Imbus, Joseph

AU - Abbott, Daniel E.

AU - Weber, Sharon M.

AU - Louie, Raphael

AU - Kim, Hong J.

AU - Martin, Robert C.G.

AU - Scoggins, Charles R.

AU - Bentrem, David J.

AU - LeCompte, Michael T.

AU - Idrees, Kamran

AU - Lopez-Aguiar, Alexandra G.

AU - Maithel, Shishir K.

AU - Kooby, David A.

AU - Franco, Daniel A.

AU - Yakoub, Danny

AU - Ahmad, Syed A.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - OBJECTIVE: The relevance of margin positivity on recurrence after resection of intraductal papillary mucinous neoplasms (IPMNs) is poorly defined and represents one reason controversy remains regarding optimal surveillance recommendations. METHODS: Patients undergoing surgery for noninvasive IPMN at 8 academic medical centers from the Central Pancreas Consortium were analyzed. A positive margin was defined as presence of IPMN or pancreatic intraepithelial neoplasia. RESULTS: Five hundred two patients underwent surgery for IPMN; 330 (66%) did not have invasive cancer on final pathology and form the study cohort. Of these, 20% harbored high grade dysplasia. A positive margin was found in 20% of cases and was associated with multifocal disease (P = 0.02). The majority of positive margins were associated with low grade dysplasia. At a median follow-up of 36 months, 34 (10.3%) patients recurred, with 6.7% developing recurrent cystic disease and 3.6% developing invasive cancer. On multivariate analysis, margin positivity was not associated with recurrence of either IPMN or invasive cancer (P > 0.05). No association between margin status and development of recurrence at the margin was found. Only 6% of recurrences developed at the resection margin and median time to recurrence was 22 months. Of note, 18% of recurrences occurred > 5 years following surgery. CONCLUSION: Margin positivity after resection for noninvasive IPMNs is primarily due to low grade dysplasia and is not associated with developing recurrence in the remnant pancreas or at the resection margin. Long-term surveillance is required for all patients, as a significant number of recurrences developed over 5 years after the index operation.

AB - OBJECTIVE: The relevance of margin positivity on recurrence after resection of intraductal papillary mucinous neoplasms (IPMNs) is poorly defined and represents one reason controversy remains regarding optimal surveillance recommendations. METHODS: Patients undergoing surgery for noninvasive IPMN at 8 academic medical centers from the Central Pancreas Consortium were analyzed. A positive margin was defined as presence of IPMN or pancreatic intraepithelial neoplasia. RESULTS: Five hundred two patients underwent surgery for IPMN; 330 (66%) did not have invasive cancer on final pathology and form the study cohort. Of these, 20% harbored high grade dysplasia. A positive margin was found in 20% of cases and was associated with multifocal disease (P = 0.02). The majority of positive margins were associated with low grade dysplasia. At a median follow-up of 36 months, 34 (10.3%) patients recurred, with 6.7% developing recurrent cystic disease and 3.6% developing invasive cancer. On multivariate analysis, margin positivity was not associated with recurrence of either IPMN or invasive cancer (P > 0.05). No association between margin status and development of recurrence at the margin was found. Only 6% of recurrences developed at the resection margin and median time to recurrence was 22 months. Of note, 18% of recurrences occurred > 5 years following surgery. CONCLUSION: Margin positivity after resection for noninvasive IPMNs is primarily due to low grade dysplasia and is not associated with developing recurrence in the remnant pancreas or at the resection margin. Long-term surveillance is required for all patients, as a significant number of recurrences developed over 5 years after the index operation.

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