| [ Summary ] |
IPMT (intraductal papillary-mucinous tumors) of the pancreas are now known to be common cystic neoplasms, often found in eldery people. Most exhibit a slow growing nature. In the therapeutic strategy for IPMT, it is most important to select the appropriate cases for surgical resection. Formerly, all of the lesions suspected of being intraductal papillary-mucinous adenomas (IPMA) and intraductal papillary-mucinous adenocarcinomas (IPMC) were candidates for this operation. However, now it is thought resected cases should be limited to advanced lesions suspected to be IPMC and invasive cancer originating from IPMC. In this paper, we discussed the criteria for surgical approaches based on our experience and published papers. IPMT is divided into two types according to the location of mural nodules and biological behavior. Since the main pancreatic duct type IPMT has clear malignant potential, all of these cases should be resected. On the other hand, the branch duct type IPMT shows a wide spectrum of histological characteristics, including non-neoplastic lesions (namely hyperplasia), IPMA and IPMC. Therefore we need to employ complex criteria, including the height of mural nodules, the maximum size of dilated branches and the diameter of the main pancreatic ducts to distinguish hyperplastic lesions from other neoplasms. Concerning clinical follow ups for IPMT, we should pay attention to metachronous multifocal lesions in the pancreas and other malignancies for long term surveillance. |