Recurrence after the surgical resection of an intraductal papillary mucinous neoplasm of the pancreas

Two papers highlight the risk of recurrence after the surgical resection of an intraductal papillary mucinous neoplasm of the pancreas
Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are non-invasive precancerous lesions, some of which, over time progress to invasive pancreatic cancer. If an intraductal papillary mucinous neoplasms of the pancreas is removed, it will not progress to invasive cancer. Intraductal papillary mucinous neoplasms of the pancreas therefore represent an opportunity to cure a pancreas tumor, before it becomes cancer.
While removing an intraductal papillary mucinous neoplasm of the pancreas prevents the lesion that was removed from progressing to pancreas, the remnant (remaining) pancreas remains at risk. Just as patients who have had a colon polyp removed need to be more carefully monitored for more colon tumors, so too do patients who have had an intraductal papillary mucinous neoplasms of the pancreas surgically resected need to be monitored for additional pancreas tumors.
Two papers that were just published help answer important questions in the post-operative monitoring of these patients.
https://www.ncbi.nlm.nih.gov/pubmed/30413822
https://www.ncbi.nlm.nih.gov/pubmed/31463655
First, what is the magnitude of the risk of recurrence after the surgical resection of an intraductal papillary mucinous neoplasm of the pancreas? The reported risk varies, but these two papers, combined with several previously published papers, suggest that the risk of getting a new significant lesion in the remnant pancreas in the five years after surgery is in the range of 5-15%. Patients who had an intraductal papillary mucinous neoplasm of the pancreas with “high-grade dysplasia” resected have a higher risk than do patients who had an intraductal papillary mucinous neoplasm of the pancreas with “low-grade dysplasia” resected.
Second, does the risk ever go down to zero, or do we have to monitor patients indefinitely? Both studies suggest that the risk persists. One cannot identify a certain number of years after surgery where it is safe to stop monitoring. In fact, both studies show that the risk persists well beyond five years after surgery.
Why is this important? These studies reinforce a growing body of literature that emphasize the importance of monitoring patients who have had an intraductal papillary mucinous neoplasm of the pancreas resected. They also show that this monitoring should, when clinically indicated, be indefinite.
For more information, visit: http://pathology.jhu.edu/pancreas/cyst/index.php

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