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Survival After Pancreatic Resection for Intraductal Papillary Mucinous Neoplasm : Supporting Selective Surgery

Holmberg, Marcus ; Dall'Olio, Tomaso ; Marwa, Mohamed ; Hansen, Carsten Palnaes ; Kleive, Dyre Berg ; Nappo, Gennaro ; Shi, Lam ; Sandström, Per ; Björk, Dennis and Hadesi, Parsa , et al. (2026) In United European Gastroenterology Journal 14(3).
Abstract

INTRODUCTION: Resection of intraductal papillary mucinous neoplasm (IPMN) aims to prevent progression to invasive pancreatic cancer. However, the risks of pancreatic surgery and frequent findings of low-grade dysplasia (LGD) raise concerns about overtreatment. This EAHPBA-endorsed multinational study evaluated short- and long-term overall survival (OS) following preventive resection for IPMN (without pre-operative signs of cancer).

METHODS: Adult patients with resected IPMN showing LGD, high grade dysplasia (HGD) or T1-staged invasive carcinoma from 2008-2023 were identified from the OPTIMAL-IPMN database. Estimated OS rates at one, five and 10 years in patients undergoing preventive pancreatic resection were assessed using... (More)

INTRODUCTION: Resection of intraductal papillary mucinous neoplasm (IPMN) aims to prevent progression to invasive pancreatic cancer. However, the risks of pancreatic surgery and frequent findings of low-grade dysplasia (LGD) raise concerns about overtreatment. This EAHPBA-endorsed multinational study evaluated short- and long-term overall survival (OS) following preventive resection for IPMN (without pre-operative signs of cancer).

METHODS: Adult patients with resected IPMN showing LGD, high grade dysplasia (HGD) or T1-staged invasive carcinoma from 2008-2023 were identified from the OPTIMAL-IPMN database. Estimated OS rates at one, five and 10 years in patients undergoing preventive pancreatic resection were assessed using Kaplan-Meier analyses and predictors for mortality were evaluated using parametric survival regressions.

RESULTS: Among 2275 patients in the OPTIMAL-IPMN database, 1728 (77%) had undergone preventive pancreatic resection for IPMN. Of those were 61% resected without prior surveillance. Final pathology revealed LGD in 63%, HGD in 27% and T1a-c-staged invasive cancer in 10% (7.3% T1a-b, 2.8% T1c). Estimated 1-year OS rate was 97%. Estimated 5-year OS rates (landmark analysis at 1 year) for LGD, HGD, T1a-b, and T1c was 97%, 99%, 96% and 91% respectively. Independent predictors for long-term mortality included age ≥ 75 versus < 75 years (HR 1.97) and T1c versus LGD (HR 8.12).

CONCLUSION: This multinational study confirms excellent survival after preventive IPMN resection but reveals many upfront resections yielding LGD with unknown survival benefit. Future studies should aim to determine which patients can be followed safely with monitoring to avoid unnecessary immediate resection.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Male, Female, Aged, Middle Aged, Pancreatectomy/mortality, Pancreatic Neoplasms/surgery, Pancreatic Intraductal Neoplasms/surgery, Kaplan-Meier Estimate, Survival Rate, Carcinoma, Pancreatic Ductal/surgery, Neoplasm Staging, Adenocarcinoma, Mucinous/surgery, Aged, 80 and over, Adult, Retrospective Studies
in
United European Gastroenterology Journal
volume
14
issue
3
article number
e70199
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:105033668038
  • pmid:41874453
ISSN
2050-6406
DOI
10.1002/ueg2.70199
language
English
LU publication?
yes
additional info
© 2026 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.
id
55cbca27-095f-436a-b5ff-18071ed84272
date added to LUP
2026-04-22 12:46:41
date last changed
2026-05-21 05:48:27
@article{55cbca27-095f-436a-b5ff-18071ed84272,
  abstract     = {{<p>INTRODUCTION: Resection of intraductal papillary mucinous neoplasm (IPMN) aims to prevent progression to invasive pancreatic cancer. However, the risks of pancreatic surgery and frequent findings of low-grade dysplasia (LGD) raise concerns about overtreatment. This EAHPBA-endorsed multinational study evaluated short- and long-term overall survival (OS) following preventive resection for IPMN (without pre-operative signs of cancer).</p><p>METHODS: Adult patients with resected IPMN showing LGD, high grade dysplasia (HGD) or T1-staged invasive carcinoma from 2008-2023 were identified from the OPTIMAL-IPMN database. Estimated OS rates at one, five and 10 years in patients undergoing preventive pancreatic resection were assessed using Kaplan-Meier analyses and predictors for mortality were evaluated using parametric survival regressions.</p><p>RESULTS: Among 2275 patients in the OPTIMAL-IPMN database, 1728 (77%) had undergone preventive pancreatic resection for IPMN. Of those were 61% resected without prior surveillance. Final pathology revealed LGD in 63%, HGD in 27% and T1a-c-staged invasive cancer in 10% (7.3% T1a-b, 2.8% T1c). Estimated 1-year OS rate was 97%. Estimated 5-year OS rates (landmark analysis at 1 year) for LGD, HGD, T1a-b, and T1c was 97%, 99%, 96% and 91% respectively. Independent predictors for long-term mortality included age ≥ 75 versus &lt; 75 years (HR 1.97) and T1c versus LGD (HR 8.12).</p><p>CONCLUSION: This multinational study confirms excellent survival after preventive IPMN resection but reveals many upfront resections yielding LGD with unknown survival benefit. Future studies should aim to determine which patients can be followed safely with monitoring to avoid unnecessary immediate resection.</p>}},
  author       = {{Holmberg, Marcus and Dall'Olio, Tomaso and Marwa, Mohamed and Hansen, Carsten Palnaes and Kleive, Dyre Berg and Nappo, Gennaro and Shi, Lam and Sandström, Per and Björk, Dennis and Hadesi, Parsa and De Rosa, Raffaele Vincenzo and Andersson, Bodil and Ansari, Daniel and Chikkala, Bhargava and Todeschini, Letizia and Leseman, Charlotte and Schuitema, Job and Lodewijks, Yentl and Månsson, Christopher and Delis, Spiros and Berrevoet, Frederik and Giannone, Fabio and Xenaki, Sofia and Pando, Elizabeth and Bertrand, Claude and Vasileiadis, Konstantinos and Kirchweger, Patrick and Ciulla, Calogero and Luchini, Claudio and Luyer, Misha and Besselink, Marc G and Marchegiani, Giovanni and Pandanaboyana, Sanjay and Tingstedt, Bobby and Sulpice, Laurent and Wennerblom, Johanna and Björnsson, Bergthor and Balakrishnan, Anita and Labori, Knut Jørgen and Burgdorf, Stefan Kobbelgaard and Qadan, Motaz and Sparrelid, Ernesto and Pea, Antonio and Hernandez-Barco, Yasmin G and Salvia, Roberto and Ghorbani, Poya}},
  issn         = {{2050-6406}},
  keywords     = {{Humans; Male; Female; Aged; Middle Aged; Pancreatectomy/mortality; Pancreatic Neoplasms/surgery; Pancreatic Intraductal Neoplasms/surgery; Kaplan-Meier Estimate; Survival Rate; Carcinoma, Pancreatic Ductal/surgery; Neoplasm Staging; Adenocarcinoma, Mucinous/surgery; Aged, 80 and over; Adult; Retrospective Studies}},
  language     = {{eng}},
  number       = {{3}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{United European Gastroenterology Journal}},
  title        = {{Survival After Pancreatic Resection for Intraductal Papillary Mucinous Neoplasm : Supporting Selective Surgery}},
  url          = {{http://dx.doi.org/10.1002/ueg2.70199}},
  doi          = {{10.1002/ueg2.70199}},
  volume       = {{14}},
  year         = {{2026}},
}