Clinical Study Of Invasive And Non-invasive IPMN

Background:IPMNs are considered to be intraductal mucin-producing cyst or cysts confined to the pancreas.It has been noted that during the recent decade,there is a considerable increase in the incidence of the disease with increasing potential of developing invasive type IPMN.Pre-operative diagnosis of malignancy and successful resection of the disease remains problematic.Reported results of long-term survival rate with minimal recurrence following resection are conflicting.The aim of this study is a comparison of the two different subtypes of IPMN which is non-invasive and invasive IPMN in terms of incidence,demographics,the most occurring symptoms,location of the tumor in both the subtypes,the pathology and histopathology of non-invasive and invasive IPMN,the most used pancreatic resection in both subtypes and The most occurring post-operative complications.However,the main aim is to compare the 5 years survival and 5 years recurrence rate in both non-invasive IPMN and invasive IPMN.The distinction between mortality rate due to recurrence and mortality due to other causes is also done.Methods:The internet is screened for articles containing information on non-invasive and invasive IPMN with special interest of survival and recurrence among those 2 subtypes of IPMN.Appropriate information is extracted to support the writing and elaboration of this comparative study and finally,11 different studies from various part of the world published by renowned authors in the field of IPMN are chosen to provide their data for this study.8 of those studies are used for comparing survival rate and 9 studies are used for distinguishing recurrence rate among non-invasive and invasive IPMN.A series of forest plot graph are plotted in order to show the distinction between the different parameters of the studies.The generated data by the graph,together with the analysis of the raw data provided by those 11 studies helped to compare the different outcomes in this study.Revman 5.3,from the Cochrane library,is used as the statistical analysis software.Results:Incidence of non-invasive IPMN vs.invasive IPMN reported to be in favor of non-invasive IPMN(odd ratio 3.41 with 95%CI:2.94-3.97,p<0.00001).Age of incidence of IPMN is between 60-70 years old with a male to female ratio of 1:1.Abdominal pain is recorded to be.the most common symptoms of patients suffering from IPMN.Head of the pancreas is the most occurring location and carcinoma-in-situ is the most occurring in non-invasive IPMN with tubular type being the most occurring in invasive IPMN.Whipple surgery is the most performed resection for IPMN and fistula has been shown to be the most common post-operative complication.Survival vs.mortality in non-invasive IPMN shown to be in favor of survival(odd ratio 31.76 with 95%CI:21.87-46.12,p<0.00001).Survival vs.mortality in invasive IPMN,showed favor in survival(odd ratio 1.57 with 95%CI:1.14-2.16,p=0.006).Survival of non-invasive IPMN vs.survival of Invasive IPMN results favoring survival of non-invasive IPMN(odd ratio 6.36 with 95%CI:4.22-9.61,p<0.00001).Overall 5 years survival rate for IPMN is 74%.Recurrence vs.non-recurrence in Non-Invasive IPMN,shown to be completely in favor of non-recurrence(odd ratio 0.00 with 95%CI:0.00-0.01,p<0.00001).Recurrence vs.non-recurrence in Invasive IPMN,tends to favor non-recurrence(odd ratio 0.24 with 95%CI:0.18-0.33,p<0.00001).Recurrence of Non-invasive IPMN vs.recurrence of invasive IPMN reported to be in favor of recurrence of invasive IPMN(odd ratio 0.09 with the 95%CI:0.06-0.15,p<0.00001).Overall 5 years recurrence rate for IPMN is 19%.Death due to recurrence of both non-invasive and invasive IPMN vs.death due to other causes reported to be in favor of death due to recurrence of both non-invasive and invasive IPMN(odd ratio 4.22 with 95%CI:2.22-8.03,p<0.0001).Conclusion:Based on the findings in this study,it is noted that most patients who are diagnosed with IPMN whether being non-invasive or invasive,are mostly aged between 60 to70 years old with an incidence of occurrence of 1:1 in both males and females.However,there is a slight predilection towards males in Asian countries and a slight predilection towards females among the Americans and Europeans.It is also noted that most of the patients diagnosed with IPMN are mostly reported to the hospital with abdominal pain as their main symptom and also a large number of patients are sometimes asymptomatic.Hence most of those patients,who are asymptomatic,are diagnosed with IPMN incidentally.The head of the pancreas seems predominantly to be the most often occurring site of IPMN.Based on the pathology point of view,the result showed that non-invasive IPMN bears the highest percentage of incidence as compared to invasive IPMN,which is reassuring as those patients with non-invasive IPMN usually have a better prognosis.However,the result showed that carcinoma-in-situ accounted for a pretty higher incidence than adenoma and borderline among the non-invasive IPMN patients which probably can explain the fact that why there is still recurrence in non-invasive IPMN.Among Invasive IPMN,it has been found that tubular type is the most occurring.Whipple surgery,whether it is the normal procedure or slightly modified procedure seems to be most often used as pancreatic resection of IPMN.The use of neoadjuvant/adjuvant therapy as a curative measure of IPMN seems to be indecisive and more studies need to be done on that topic.Regarding peri-operative complications post-surgical resection,it has been concluded that fistula bears the highest rate of incidence followed by delayed gastric emptying and intra-abdominal collections.The 5 years survival rate among non-invasive patients completely surpasses the rate of survival among invasive patients and the rate of recurrence is much more elevated in invasive IPMN than non-invasive IPMN patients.The result of the comparison of the rate of death due to recurrence of IPMN against death due to other causes,showed that many patients die due to recurrence after having a curative pancreatic resection rather than other causes.