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.

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.; Stattner, 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.

All Authors

Lucocq, J.

Halle-Smith, J.

Haugk, B.

Joseph, N.

Hawkyard, J.

Lye, J.

Parkinson, D.

White, S.

Mownah, O.

Zen, Y.

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LTHT Author

Helliwell, Jack
Young, Alistair
Marks, Kate

LTHT Department

Hepatobiliary Surgery
Pancreas Unit

Publication Date

2025

Item Type

Journal Article
Comparative Study
Multicenter Study

Abstract

OBJECTIVE: The aim of the present study was to compare long-term postresection oncological outcomes between adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) and pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Knowledge of long-term oncological outcomes (e.g. recurrence and survival) comparing A-IPMN and PDAC is scarce. METHODS: Patients undergoing pancreatic resection (2010-2020) for A-IPMN were identified retrospectively from 18 academic pancreatic centers and compared with PDAC patients from the same time period. Propensity-score matching was performed, and survival and recurrence were compared between A-IPMN and PDAC. RESULTS: In all, 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 (47.3% vs. 72.3%) and R1 resection (38.6% vs. 56.3%) compared with PDAC ( P <0.001). The median survival and time-to-recurrence for A-IPMN versus PDAC were 39.0 versus 19.5 months ( P <0.001) and 33.1 versus 14.8 months ( 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). The 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 with 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.