CONSERVATIVE SURGERY FOR PANCREATIC IPMNS: PROGNOSTIC IMPACT ON TUMOR PROGRESSION AND ON QUALITY OF LIFE

Background: The extent of pancreatic resection for IPMNs remains an unresolved issue; although total pancreatectomy(TP) would definitively prevent metachronous progression to IPMNs or PDACs, metabolic consequences can seriously affect the quality of life. The aim of this study is to analyze the prognostic impact of conservative surgery for IPMNs. Methods: We retrospectively analyzed data of pancreatic resections for IPMN performed at our center in a ten-years period. Patients were divided in three groups: 1) patients with worrisome features at preoperative imaging and with histopathological proven IPMN with low to high grade dysplasia (IPMN group); 2) patients with IPMN with worrisome features at preoperative imaging and with histopathological accidental findings of carcinoma (IPMN-PDAC group); 3) patients with PDAC at preoperative imaging and with histopathological finding of collateral IPMN (PDAC-IPMN group). The Kaplan-Meier method was used to compare overall survival(OS) and disease-free survival(DFS). Results: From November 2007 to December 2017, 467 patients underwent pancreatic resections, 108 of which had IPMNs: 25 patients were included in IPMN group, 20 in IPMN-PDAC group and 63 in PDAC-IPMN group. The mean follow-up was 37.13.0 months. Conservative surgery was performed in 55% of patients, while 49(45%) patients underwent TP. In IPMN group the OS and DFS were 117.6 and 141.6 months, in IPMN-PDAC group 37.8 and 36.6 months and in PDAC-IPMN group 47.9 and 60.8 months respectively. None of patients undergone conservative surgery needed a completion of pancreatectomy due to the progression of IPMN lesions with worrisome features or PDAC in the remnant pancreas during the follow-up. Comparing OS and DFS, we found a significant better prognosis only for IPMN group (p<0.05). No differences were found between partial or total pancreatectomy in terms of OS and DFS. Only 22.4% of patients developed diabetes after conservative surgery. Conclusions: The prognosis of patients undergoing pancreatic resection for IPMN depends on the presence of malignant progression of the IPMN, and not on the extension of surgery. A conservative surgery can be considered an appropriate choice, thus avoiding serious long-term metabolic consequences.