Concise Commentary: Presurgical Evaluation of IPMNs—Eight Is Enough

Excerpt

Optimal management of intraductal papillary mucinous neoplasia (IPMN), a premalignant pancreatic cystic tumor often discovered incidentally by imaging studies, represents a major challenge for clinicians, who must balance the risk/benefit of observation versus resection. The main goal of intervention for patients with IPMN is to prevent development of pancreatic ductal adenocarcinoma. IPMN is clearly a precursor to pancreatic ductal adenocarcinoma (PDAC), and despite the relatively improved outcome of patients with PDAC arising in IPMN, the ultimate outcome once malignancy develops is uniformly fatal. Thus, the stakes are quite high with this premalignant cystic neoplasm in patients who are simply observed. Conversely, despite improvements in operative technique and perioperative care, pancreatectomy is still a major undertaking. Not only are patients at relatively high risk for immediate perioperative complications (and in a small percentage mortality), the long-term consequences of pancreatectomy have substantial health impact with complications such as endocrine and exocrine insufficiency combined with the sequelae of surgical manipulation such as marginal ulceration in patients undergoing pancreatic head resection. Furthermore, surgical resection of IPMN does not completely eliminate the need for long-term observation: after resection of a primary (solitary) IPMN, 10–15% of patients will develop new IPMN within the pancreatic remnant. …