356 Characteristics of Presentation, Surgical and Adjuvant Management of Adenocarcinoma Arising in IPMNs of the Pancreas: A Case Series from a UK Tertiary Referral Centre

Abstract Aim Intraductal papillary mucinous neoplasms (IPMNs) represent precursor lesions to pancreatic adenocarcinoma. This case series evaluates the presentation, management, and outcomes of patients with invasive carcinoma arising from IPMNs at a UK tertiary centre. Method Between January 2017 and December 2023, 28 patients with IPMN-associated adenocarcinoma underwent evaluation and management. Demographic, radiological, surgical, pathological, and outcome data were retrospectively analysed. Results Median age at diagnosis was 69 years (IQR 62–74). High-risk radiological features were identified preoperatively in 19/28 patients (67.8%). Median CA 19-9 at diagnosis was 66 U/mL (IQR 30–215; n=19), rising to 298 U/mL preoperatively (IQR 24–500; n=9). One patient received neoadjuvant chemotherapy. Median interval from diagnosis to surgery was 107 days (IQR 59–205). Surgical interventions included 14 Whipple’s/PPPDs (including one completion pancreatectomy), 2 distal pancreatectomies, and 12 total pancreatectomies. Postoperative morbidity included 3 grade B pancreatic fistulas; there was no 90-day mortality. Histopathology revealed ductal/tubular differentiation in 23 patients and colloid in 5; 19 had moderately differentiated tumours, with perineural invasion present in 17 and nodal involvement in 13. Sixteen patients received adjuvant chemotherapy. Disease recurrence occurred in 11 patients, with a median time to recurrence of 16.9 months (IQR 12.9–24.7). Median survival was 3.6 years (IQR 1.3–5.1), with overall survival of 46.4%. Conclusions IPMN-associated adenocarcinomas present variably, often with high-risk features. Surgical resection with multidisciplinary management achieves favourable short-term outcomes. Long-term prognosis remains guarded, highlighting the need for improved surveillance and adjuvant strategies.