Postoperative Outcomes and Strategic Refinement in Intraductal Papillary Mucinous Neoplasm Management: A Single...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Intraductal papillary mucinous neoplasm (IPMN) is a pancreatic precursor lesion with variable malignant potential.
• Heterogeneity of IPMN leads to controversial treatment strategies regarding surgery and surveillance.
• Institutional outcomes were reviewed to refine management guidelines for IPMN.

Purpose of the Study:

• To reassess current postoperative strategies for IPMN.
• To refine management guidelines for IPMN based on institutional outcomes.
• To evaluate the accuracy of preoperative diagnosis versus final pathological findings in IPMN.

Main Methods:

• Retrospective analysis of 49 IPMN patients who underwent pancreatectomy.
• Data collected from an academic institution between 2015 and May 2025.
• Evaluation of diagnostic mismatch, prognostic factors, and survival outcomes.

Main Results:

• A 39% diagnostic mismatch between preoperative and final pathology was observed, with overdiagnosis being more frequent.
• Main pancreatic duct dilation and elevated amylase levels were associated with overdiagnosis.
• Histological grade significantly impacted prognosis: adenoma/carcinoma in situ had favorable outcomes, while invasive IPMN had poor survival (5-year OS 36%).
• Elevated CA19-9, lymph node metastasis, and advanced tumor stage were significant negative prognostic factors.
• Cancer recurrence occurred in 18% of patients, mainly through peritoneal and hepatic routes.

Conclusions:

• Preoperative diagnostic inaccuracies are common in IPMN management.
• Invasive transformation, elevated CA19-9, lymph node metastasis, and tumor stage are critical prognostic indicators.
• A multimodal diagnostic approach is essential for improved risk stratification and surgical management of IPMN.