| Theme | The Current State of Management of Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas | |
|---|---|---|
| Title | Practical Guidelines for IPMN | |
| Publish Date | 2014/12 | |
| Author | Tatsuji Yogi | Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author | Susumu Hijioka | Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author | Nobumasa Mizuno | Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author | Kazuo Hara | Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author | Hiroshi Imaoka | Department of Gastroenterology, Aichi Cancer Center Hospital |
| Author | Kenji Yamao | Department of Gastroenterology, Aichi Cancer Center Hospital |
| [ Summary ] | In the revised guidelines, the criterion for characterizing main duct-type intraductal papillary mucinous neoplasms (MD-IPMN) has been lowered to a main pancreatic duct diameter (MPD) dilation of >5 mm. Surgical resection is recommended for MD-IPMN with MPD dilation ≥10 mm. However, a MPD dilation of 5-9 mm should be considered one of the "worrisome features", as is the case for branchduct (BD)-IPMN, with a recommendation for further surveillance, but no need for immediate surgical resection. "High-risk stigmata" and "worrisome features" have been used to stratify the risk of malignancy in BD-IPMN, and to consider early surgical resection or increased surveillance. In Japan, some experts advocate continuation of surveillance every 6 months because of the relatively high incidence of pancreatic ductal adenocarcinoma in patients with BD-IPMN. The imaging findings (mural nodule, MPD dilatation, cyst size, thickened cyst walls) are used to distinguish malignant from benign BD-IPMNs, including the mixed-type IPMN. Preoperative pancreatic juice with MUC-staining may provide useful information for deciding on surgical intervention. |
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