Total versus Partial Pancreatectomy in Patients with Pancreatic Cancer Arising from Multifocal or Diffuse Intraductal Papillary Mucinous Neoplasia - A Multicenter Observational Study.

Autor:	Rompen IF; New York University Langone Health, Department of Surgery, New York, USA.; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands., Habib JR; New York University Langone Health, Department of Surgery, New York, USA.; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Kinny-Köster B; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Campbell BA; Johns Hopkins Hospital, Department of Surgery, Baltimore, USA., Stoop TF; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, the Netherlands., Kümmerli C; University of Basel, Clarunis University Digestive Health Care Center, Basel, Switzerland., Andel PCM; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Leseman CA; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands.; Cancer Center Amsterdam, the Netherlands., Lesch C; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Daamen LA; University Medical Center Utrecht, Division of Imaging and Oncology, Utrecht, the Netherlands., Javed AA; New York University Langone Health, Department of Surgery, New York, USA., Lafaro KJ; Johns Hopkins Hospital, Department of Surgery, Baltimore, USA., Nienhüser H; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Billeter AT; University of Basel, Clarunis University Digestive Health Care Center, Basel, Switzerland., Molenaar IQ; Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Department of Surgery, Utrecht, the Netherlands., Müller-Stich BP; University of Basel, Clarunis University Digestive Health Care Center, Basel, Switzerland., Besselink MG; Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands., He J; Johns Hopkins Hospital, Department of Surgery, Baltimore, USA., Loos M; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany., Büchler MW; Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.; Department of Pancreatic Surgery, Champalimaud Foundation, Lisbon, Portugal., Wolfgang CL; New York University Langone Health, Department of Surgery, New York, USA.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2024 Sep 18. Date of Electronic Publication: 2024 Sep 18.
DOI:	10.1097/SLA.0000000000006538
Abstrakt:	Aim: To investigate the impact of total pancreatectomy (TP) on oncological outcomes for patients at high-risk of local recurrence or secondary progression in the remnant gland after partial pancreatectomy (PP) for IPMN-associated cancer. Summary Background Data: Major risk factors for invasive progression in the remnant gland include multifocality, diffuse main duct dilation, and the presence of invasive cancer. In these high-risk patients, a TP may be oncologically beneficial. However, current guidelines discourage TP, especially in elderly patients. Methods: This international multicenter study compares TP versus PP in patients with adenocarcinoma arising from multifocal or diffuse IPMN (2002-2022). Log-rank test and multivariable Cox-analysis with interaction analysis was performed to assess overall survival (OS), disease-free survival (DFS), and local-DFS. Results: Of 359 included patients, 162 (45%) were treated with TP, whereas 197 (55%) underwent PP. Despite TP and PP having similar R0-rates (59% vs. 58%, P=0.866), patients undergoing a TP had significantly longer local-DFS compared to PP (P=0.039). However, no difference in OS was observed between the two surgical approaches (P=0.487). In a multivariable analysis, young age (optimal cut-off ≤63.6 yrs) was associated with an OS benefit derived from TP (HR:0.44, 95%CI:0.22-0.89), whereas no significant difference was observed in elderly patients (HR:1.24, 95%CI:0.92-1.67, Pinteraction=0.007). Conclusion: Since overall, patients with diffuse or multifocal IPMN with an invasive component do not benefit from TP in terms of OS, the indication for TP may be individualized to young patients who have sufficient life expectancy to benefit from the prevention of secondary progression or local recurrence. Competing Interests: Conflicts of Interest: None declared. Disclosures: There are no conflicts of interest for any of the authors. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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