Impact of pancreatic margin status and lymph node metastases on recurrence after resection for invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis

Dig Surg. 2012;29(3):213-25. doi: 10.1159/000339334. Epub 2012 Jun 7.


Background: Accurate information is currently lacking regarding the values of positive margins (M(+)) and lymph node (LN) metastases as independent predictors of postoperative recurrence in invasive and noninvasive intraductal papillary mucinous neoplasms (IPMNs) of the pancreas.

Methods: A comprehensive online literature search identified all types of primary studies that included M(+) and LN metastases as risk factors and defined recurrence as an outcome in patients with IPMNs. Suitable articles were also identified by manually researching references in qualifying articles. A meta-analysis of the result was performed using a random effects model.

Results: The recurrence rate in noninvasive IPMNs was 3.72% in patients with negative margin (M(-)) versus 9.56% in those with M(+) (odds ratio, OR = 0.37, 95% confidence interval, 95% CI: 0.17-0.78, p = 0.010). The recurrence rate in invasive M(-) IPMNs in was 33.85% compared to 53.66% in M(+) IPMNs (OR = 0.47, 95% CI: 0.25-0.88, p = 0.020). The recurrence rate in invasive IPMNs with positive LN was 76.92% compared to 30.86% with negative LN; OR = 0.15, 95% CI: 0.06-0.37, p < 0.0001).

Conclusions: M(+) were associated with disease recurrence in all patients with IPMN, and nodal metastases were significantly associated with recurrence in invasive IPMN.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adenocarcinoma, Mucinous / secondary*
  • Adenocarcinoma, Mucinous / surgery
  • Carcinoma, Pancreatic Ductal / secondary*
  • Carcinoma, Pancreatic Ductal / surgery
  • Carcinoma, Papillary / secondary*
  • Carcinoma, Papillary / surgery
  • Humans
  • Lymphatic Metastasis
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / pathology*
  • Neoplasm, Residual
  • Pancreatic Neoplasms / pathology*
  • Pancreatic Neoplasms / surgery*