Introduction : There is controversy over secure margin and extent of surgery according to margin in patients of intraductal papillary mucinous neoplasms of pancreas (IPMN). This study aimed to evaluate fate of patients according to pathology and margin after surgical resection.

Methods : Total 548 patients who underwent operation for IPMN at Seoul National University Hospital between 2000 and 2018 were included in study. We analyzed survival, recurrence according to pathology and margin, and prognostic factors.

Results : Among patients, 353 had low-grade dysplasia (LGD), 78 had high-grade dysplasia (HGD), and 117 had invasive IPMN. Invasive IPMN showed worse 5-year survival rate compared to LGD and HGD (48.2% vs 88.7% vs 83.1%, p < 0.001). Total 56 patients developed recurrences (LGD vs HGD vs invasive: 2.8% vs 7.7% vs 34.2%), and CA19-9 > 37 (hazard ration [HR] 2.412, p < 0.001), invasive IPMN (HR 10.393, p < 0.001), and malignant margin (HGD or invasive IPMN) (HR 3.116, p < 0.007) were associated with recurrence. Among invasive IPMN patients, CA 19-9 > 37 (HR 2.639, p = 0.002), malignant margin (HR 3.290, p = 0.002), chemotherapy (HR 2.008, p = 0.018), N1 stage (HR 2.213, p = 0.015), and venous invasion (HR 2.850, p = 0.003) were associated with poor disease-free survival.

Conclusions : IPMN with malignant margin needs additional resection to achieve negative, or at least benign (LGD) margin. Regular follow-up is also needed in LGD, HGD patients, and more efficient adjuvant chemotherapy is required for prevention of systemic recurrence and long-term survival, especially in invasive IPMN.