Dysplasia at the surgical margin is associated with recurrence after resection of non‐invasive intraductal papillary mucinous neoplasms

AbstractBackgroundThe significance of a positive margin in resected non‐invasive pancreatic intraductal papillary mucinous neoplasms (IPMN) remains controversial. The aim of this study was to determine recurrence rates when dysplasia was present at the final surgical margin.MethodsA prospectively maintained database identified 192 patients undergoing resection of non‐invasive IPMN. Pathological, peri‐operative and recurrence data were analysed.ResultsDuctal dysplasia was identified at the final surgical margin in 86 patients (45%) and defined as IPMN or Pancreatic Intraepithelial Neoplasia PanIN in 38 (20%) and 54 (28%) patients, respectively. At a median follow‐up of 46 months, 40 (21%) patients recurred with 31 developing radiographical evidence of new cysts, 6 re‐resected for IPMN and 3 diagnosed with pancreatic cancer within the remnant. Of those with margin dysplasia, 31% developed recurrent disease compared with 13% in those without dysplasia (P = 0.002). On multivariate analysis, margin dysplasia was associated with a three‐fold increased risk of recurrence (P = 0.02). No relationship between dysplasia and development of pancreatic cancer was found.DiscussionIn this study, dysplasia at the margin after a pancreatectomy for non‐invasive IPMN was associated with recurrence in the remnant gland, but not at the resection margin. While this finding may warrant closer follow‐up, it does not identify a gland at higher risk for the subsequent development of invasive disease