Selecting optimal surgical procedures for intraductal papillary mucinous neoplasm (IPMN): An analysis based on the Surveillance, Epidemiology, and End Result registry database

Intraductal papillary mucinous neoplasm (IPMN) is a field defect disease of pancreas that has malignant potential. Many studies have recommended surgery as the preferred treatment. We investigated whether a total pancreatectomy (TP) can improve patient prognosis compared to a pancreatoduodenectomy (PD) and the indications for each approach.

We obtained data of 548 malignant IPMN patients who underwent either a TP or a PD from SEER database. The survival rates were analyzed using the Kaplan-Meier method and a Cox regression model. Cases were subdivided to investigate the advantages of each procedure.

The surgical procedures (PD and TP) did not significantly affect either cancer-specific survival (CSS) times or overall survival (OS) times in both Kaplan-Meier analysis and Cox regression (Kaplan-Meier: PCSS = 0.919, POS = 0.996; Cox: PCSS = 0.735, POS = 0.820). In the subgroup analyses, patients in stage T4 and AJCC stage III in the TP group had a longer survival time than did those in the PD group (33 months vs 14 months), but not significant (T4: PCSS = 0.124, AJCC III: PCSS = 0.102). In addition, PD had the trend to be better for poorly differentiated patients (Pos = 0.055) and older patients.

TP did not offer any significant OS and CSS benefits as compared to PD. However, for patients in stage T4 and AJCC stage III, TP may extend survival time in some degree. In older or histologically poorly differentiated patients, PD may be preferable to TP. The results are rational, but still warrant further verification due to limited sample volumes of specific subgroups.