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.

中文翻译：

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多灶性或弥漫性导管内乳头状粘液性肿瘤引起的胰腺癌患者的全胰腺切除术与部分胰腺切除术 - 一项多中心观察性研究。


目的 探讨全胰腺切除术 (TP) 对 IPMN 相关癌症部分胰腺切除术 (PP) 后局部复发或残余腺继发进展高风险患者的肿瘤学结果的影响。摘要背景数据残腺侵袭性进展的主要危险因素包括多灶性、弥漫性主导管扩张和侵袭性癌症的存在。对于这些高危患者，TP 可能在肿瘤学上有益。然而，目前的指南不鼓励 TP，尤其是老年患者。方法 这项国际多中心研究比较了多灶性或弥漫性 IPMN 引起的腺癌患者的 TP 与 PP（2002-2022 年）。进行对数秩检验和多变量 Cox 分析以及交互分析，以评估总生存期 (OS)、无病生存期 (DFS) 和局部 DFS。结果 在 359 名患者中，162 名 (45%) 接受了 TP 治疗，而 197 名 (55%) 接受了 PP 治疗。尽管 TP 和 PP 具有相似的 R0 率（59% vs. 58%，P=0.866），但与 PP 相比，接受 TP 的患者的局部 DFS 显着更长（P=0.039）。然而，两种手术方法之间的 OS 没有差异（P=0.487）。在多变量分析中，年轻患者（最佳截止值≤63.6岁）与TP带来的OS获益相关（HR：0.44，95％CI：0.22-0.89），而在老年患者中没有观察到显着差异（HR：0.44，95％CI：0.22-0.89） ：1.24，95%CI：0.92-1.67，Pinteraction=0.007）。结论 总体而言，具有侵袭性成分的弥漫性或多灶性 IPMN 患者在 OS 方面不会从 TP 中受益，因此 TP 的适应症可以针对具有足够预期寿命以受益于预防继发进展或局部复发的年轻患者进行个体化治疗。