Tumor location predicts presence of high grade dysplasia and invasive carcinoma in intraductal papillary mucinous neoplasms of the pancreas

Background: Traditionally, intraductal papillary mucinous neoplasms (IPMNs) of the pancreas with certain high-risk stigmata or worrisome features are referred for surgical management. We aim to assess if tumor location is associated with increased cancer risk in patients with IPMN. Methods: Perioperative data of patients that underwent resection for IPMN from seven institutions between 2000 and 2015 (n = 275) were collected. High-risk stigmata and worrisome features were defined by the 2012 Fukuoka international consensus guidelines. Logistic regression was used to identify predictors of HGD or invasive carcinoma. Results: The majority of patients, 168 (61%), were found to have head/uncinate tumors, while 107 (39%) had tumors located in the pancreas neck/body/tail. No differences were noted with regard to patient age, tumor histology and size, or presence of worrisome features between these groups. Patients with tumors confined to the head/uncinate were more often male (55% vs. 39%), had high-risk stigmata (24% vs. 11%), and more often harbored HGD or invasive carcinoma (62% vs. 33%) [all p < 0.05]. On multivariate analysis, only tumor location remained associated with presence of HGD or invasive carcinoma, with having a tumor in the head/uncinate significantly increasing odds of harboring malignancy (OR 4.76, p = 0.02). Conclusion: Tumor location is predictive of HGD or invasive carcinoma in patients with IPMNs, with tumors of the head/uncinate significantly more likely to harbor malignancy compared to those of the neck/body/tail. Evaluating tumor location is an important consideration when determining which IPMN patients should be recommended to undergo surgical resection.