Outcomes of pancreatectomy for histologically proven intraductal papillary mucinous neoplasm with reference to Fukuoka guidelines

Background: Intraductal papillary mucinous tumour (IPMN) of pancreas is increasingly recognized to have malignant potential. Fukuoka guidelines are commonly used to select patients with IPMN for resection due to high chance of malignancy, which includes high-grade dysplasia (HGD) or invasive carcinoma (IC).

Methods: A retrospective study on consecutive patients who have undergone pancreatectomy with IPMN as the final pathology was performed. Operative and survival outcomes were analysed. The positive predictive values (PPV) of high-risk stigmata (HRS) and worrisome features (WF) of Fukuoka guidelines for HGD/IC were determined.

Results: Between August 2011 and September 2020, various types of pancreatectomy were performed for 36 patients with histologically proven IPMN. They included 26 pancreaticoduodenectomy, 7 distal pancreatectomy, 2 central pancreatectomy, and 1 total pancreatectomy. There were 30 branch duct type IPMN, 5 main duct type, and 1 mixed type. There was no 30-day mortality. Overall complications and pancreatic fistula occurred in 44.4% and 5.6% of patients, respectively. Patients without HGD/IC had 100% survival at 5 years with no recurrent disease. There were 13 patients with HGD/IC, their 1-, 3-, 5-year overall and disease-free survival were 84.6%, 76.9%, 67.3% and 84.6%, 68.4%, 58.6%, respectively, both significantly shorter than non-HGD/IC group (P = 0.002 and 0.001, respectively). The PPV of HRS and WF for HGD/IC were 33.3% and 23.5%, respectively. The combined PPV of HRS and WF for HGD/IC was 38.0%.

Conclusion: Survival after pancreatectomy for IPMN was favourable, but was significantly worse in the presence of HGD/IC. Fukuoka guidelines were useful in predicting malignant IPMN.