| Theme |
The Current State of Management of Intraductal Papillary Mucinous Neoplasm (IPMN) of the Pancreas |
| Title |
Surgical Indications and Procedures for Intraductal Papillary Mucinous Neoplasms |
| Author |
Yutaka Suzuki |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Tetsuya Nakazato |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Masaaki Yokoyama |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Nobutsugu Abe |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Toshiyuki Mori |
Department of Surgery, Kyorin University School of Medicine |
| Author |
Masanori Sugiyama |
Department of Surgery, Kyorin University School of Medicine |
| [ Summary ] |
In patients with intraductal papillary mucinous neoplasms (IPMNs), malignant tumors require surgery ; however, benign tumors can be followed up without surgery, given the slow progression of IPMN. In 2012, the new International Consensus Guidelines were published；these, defined the criteria for classifying main duct-type, branch duct-type, and mixed-type IPMNs. The guidelines recommended surgery for main duct-type IPMN. For branch duct-type IPMN, the guidelines distinguish "high-risk stigmata" and "worrisome features" that suggest malignant IPMNs. Surgery is recommended for patients with "high-risk stigmata". If "worrisome features" are present, endoscopic ultrasonography (EUS) should be performed. Routine procedures such as pancreaticoduodenectomy and distal pancreatectomy with splenectomy are required for malignant IPMN. First-grade lymph node dissection is necessary for high-grade dysplasia. Furthermore, second grade dissection is necessary for IPMNs with an associated invasive carcinoma. Laparoscopic pancreatectomy is possible for high-grade dysplasia located in the pancreatic bodytail. Short-term outcomes of laparoscopic pancreatectomy are equivalent to open surgery. Limited resections for IPMN can lead to several complications such as tumor recurrence and non-clarified long-term outcome. Benign IPMN with symptoms is a good indication for limited resection surgery. |