ASO Author Reflections: The Role of Neoadjuvant Chemotherapy in Invasive Intraductal Mucinous Neoplasms of the Pancreas

Excerpt

Intraductal mucinous cystic neoplasms (IPMN) of the pancreas are relatively common,¹ and these cystic tumors have potential for progression into pancreatic ductal adenocarcinoma (PDAC), though their prognosis is debated to be less severe than that of de novo PDAC. The management of IPMN was originally addressed by the first international consensus guidelines in 2006,² which were later revised in 2012 and 2017.³ However, these IPMN guidelines mostly focus on risks of an invasive component and the surgical indications and their follow-up, without mentioning the possible role of neoadjuvant chemotherapy in IPMNs whose invasive nature has been pathologically demonstrated preoperatively. Similarly, NCCN guidelines⁴ for pancreatic cancer do not differentiate between invasive IPMN and PDAC. In modern times, high-volume centers for pancreatic surgery are oriented toward a neoadjuvant chemotherapy approach, as well as in resectable PDAC, but its use in invasive IPMN has not yet been investigated. …