Resectable invasive IPMN versus sporadic pancreatic adenocarcinoma of the head of the pancreas: Should these two different diseases receive the same treatment? A matched comparison study of the French Surgical Association (AFC)

Eur J Surg Oncol. 2017 Sep;43(9):1704-1710. doi: 10.1016/j.ejso.2017.06.011. Epub 2017 Jun 29.

Abstract

Purpose: To compare survival and impact of adjuvant chemotherapy in patients who underwent pancreaticoduodenectomy (PD) for invasive intraductal papillary mucinous neoplasm (IIPMN) and sporadic pancreatic ductal adenocarcinoma (PDAC).

Methods: From 2005 to 2012, 240 patients underwent pancreatectomy for IIPMN and 1327 for PDAC. Exclusion criteria included neoadjuvant treatment, pancreatic resection other than PD, vascular resection, carcinoma in situ, or <11 examined lymph nodes. Thus, 82 IIPMN and 506 PDAC were eligible for the present study. Finally, The IIPMN group was matched 1:2 to compose the PDAC group according to TNM disease stage, perineural invasion, lymph node ratio, and margin status.

Results: There was no difference in patient's characteristics, intraoperative parameters, postoperative outcomes, and histologic parameters. Overall survival and disease-free survival times were comparable between the 2 groups. In each group, overall survival time was significantly poorer in patients who did not achieve adjuvant chemotherapy (p = 0.03 for the IIPMN group; p = 0.03 for the PDAC group). In lymph-node negative patients of the IIPMN group, adjuvant chemotherapy did not have any significant impact on overall survival time (OR = 0.57; 95% CI [0.24-1.33]). Considering the whole population (i.e. patients with IIPMN and PDAC; n = 246), patients who did not achieve adjuvant chemotherapy had poorer survival (p < 0.01).

Conclusions: The courses of IIPMN and PDAC were similar after an optimized stage-to-stage comparison. Adjuvant chemotherapy was efficient in both groups. However, in lymph node negative patients, adjuvant chemotherapy seemed not to have a significant impact.

Keywords: Adjuvant chemotherapy; Invasive IPMN; Pancreatic adenocarcinoma; Staging.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Carcinoma, Pancreatic Ductal / pathology
  • Carcinoma, Pancreatic Ductal / secondary
  • Carcinoma, Pancreatic Ductal / therapy*
  • Chemotherapy, Adjuvant
  • Disease-Free Survival
  • Female
  • France
  • Humans
  • Lymphatic Metastasis
  • Male
  • Margins of Excision
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Neoplasm, Residual
  • Neoplasms, Cystic, Mucinous, and Serous / pathology
  • Neoplasms, Cystic, Mucinous, and Serous / secondary
  • Neoplasms, Cystic, Mucinous, and Serous / therapy*
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / therapy*
  • Pancreaticoduodenectomy
  • Peripheral Nerves / pathology
  • Survival Rate