Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are being diagnosed with increasing frequency. IPMNs comprise a histologic group that ranges from adenoma to invasive carcinoma with different degrees of aggressiveness (borderline tumor). Actually, it is not known whether all IPMNs have this malignant potential or what is the best treatment of IPMNs. The'identify the right time of surgical treatment or follow-up is the great dilemma .
Most of (70%) of main duct type intraductal papillary mucinous neoplasms harbor high-grade dysplasia or an invasive cancer. Therefore should be surgically resected if the patient can tolerate it
Most of (70%) of main duct type intraductal papillary mucinous neoplasms harbor high-grade dysplasia or an invasive cancer. Therefore should be surgically resected if the patient can tolerate it
Scientific papers (not RCTs that are impossible to be designed) reported an high incidence of malignant potential for main duct IPMN, although the chance of developing an invasive cancer is not trascurable for branch duct IPMN as well. However, pancreatic surgery could lead to some morbidity and mortality even if carried out by such a miniinvasive route (i.e laparoscopy and robotic). The balance between pros and cons of a prophylactic operation should be discussed with the patient, but reserved to very experienced-high volume centers, in order to guarantee the lowest incidence of complications after surgery.
Actually, the international literature shows as borderline IPMNs an heterogeneous group of neoplasms with a variable 5 y risk of invasive carcinoma ( main pancreatic duct:50%, branch duct IPMN: 3-18%). Khannoussi, pancreatology, 2012.
The consensus conference in Fukuoka 2012 has established the main guidelines for the treatment and follow-up of borderline IPMNS, showing clear marks of malignancy to be assessed during the follow-up.
I send you the Algorithm Fukuoka 2012.
The other guidelines for the treatment of these neoplasms are reported by Canto, Gut 2013 or in www.teamp.org.
Interesting discussion Dr. Lombardi.
In my opiniion, surgical resection is ideal for IPMN given that resection is being done for much less - in some cases of chronic pancreatitis with suspicious head mass, pancreatico-duodenectomy is performed
I recommend to have a look at the European Guidelines for cystic tumors of the pancreas
Del Chiaro M, Verbeke C, Salvia R, Klöppel G, Werner J, McKay C, Friess H, Manfredi R, Van Cutsem E, Löhr M, Segersvärd R; European Study Group on Cystic Tumours of the Pancreas. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis. 2013 Sep;45(9):703-11.
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