Treatment of branch-duct intraductal papillary mucinous neoplasms of the pancreas: state of the art

Stefano Crippa, Alessandra Piccioli, Maria Chiara Salandini, Chiara Cova, Francesca Aleotti, Massimo Falconi

Research output: Contribution to journalReview articlepeer-review

Abstract

The diagnosis of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) has been dramatically increased. BD-IPMNs are frequently discovered as incidental findings in asymptomatic individuals, mainly in elderly patients. An accurate evaluation of BD-IPMNs with high-resolution imaging techniques and endoscopic ultrasound is necessary. Patients with high-risk stigmata (HRS, obstructive jaundice, enhanced solid component) should undergo resection. Patients with worrisome features (WF, cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, and clinical acute pancreatitis) may undergo either a strict surveillance based on patients’ characteristics (age, comorbidities) or surgical resection. Non-operative management is indicated for BD-IPMNs without HRS and WF. Patients with BD-IPMN who do not undergo resection may develop malignant change over time as well as IPMN-distinct pancreatic cancer. However, non-operative management of BD-IPMNs lacking WF and HRS is safe and the risk of malignant degeneration seems relatively low. The optimal surveillance protocol is currently unclear.

Original languageEnglish
Pages (from-to)265-271
Number of pages7
JournalUpdates in Surgery
Volume68
Issue number3
DOIs
Publication statusPublished - Sep 1 2016

Keywords

  • Branch-duct
  • High-risk stigmata
  • Intraductal papillary mucinous neoplasms
  • Surgery
  • Surveillance
  • Worrisome features

ASJC Scopus subject areas

  • Surgery

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