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Surgery Today
Published in: Surgery Today 1/2020

Open Access 01-01-2020 | Endoscopic Retrograde Pancreatography | Review Article

Surgical strategy for intraductal papillary mucinous neoplasms of the pancreas

Authors: Seiko Hirono, Hiroki Yamaue

Published in: Surgery Today | Issue 1/2020

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Abstract

The current treatment strategy for intraductal papillary mucinous neoplasms (IPMNs), based on the international consensus guideline, has been accepted widely. However, reported outcomes after surgical resection for IPMN show that once the tumor progresses to invasive intraductal papillary mucinous carcinoma (IPMC), recurrence is not uncommon. The surgical treatment for IPMN is invasive and sometimes followed by complications. Therefore, the best timing for resection might be at the point when high-grade dysplasia (HGD) is evident. According to previous reports, main duct type IPMN has a high malignant potential and its surgical resection is universally accepted, whereas, the incidence of HGD/invasive IPMC in branch duct and mixed type IPMNs is thought to be lower. In addition to mural nodules and a dilated main pancreatic duct, cytology and measurement of the carcinoembryonic antigen level in the pancreatic juice might be useful to differentiate HGD/invasive IPMC from low-grade dysplasia. The nomogram proposed recently to predict the risk of HGD/invasive IPMC in IPMN patients might help surgeons decide on the best treatment strategy, depending on the patient’s age and general condition. Second resection for high-risk lesions in the remnant pancreas might improve the survival of IPMN patients.
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Metadata
Title
Surgical strategy for intraductal papillary mucinous neoplasms of the pancreas
Authors
Seiko Hirono
Hiroki Yamaue
Publication date
01-01-2020
Publisher
Springer Singapore
Published in
Surgery Today / Issue 1/2020
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-019-01931-5

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