Intraductal Papillary Mucinous Neoplasm-When to Resect?

摘要: Based on the experience to date with IPMNs, approach patients remains relatively complex. A meticulous and careful diagnosis, oncologic risk assessment, operative planning, surveillance is needed adequately address these lesions. Indications for resection in IPMN are (1) cancer, (2) cancer prevention at high malignant transformation, (3) management of symptoms. Differentiating who have IPMNs by type an important initial step providing optimal care (Fig. 6). In MPD involvement (main- mixed-type IPMN), malignancy too justify nonoperative unless comorbidity or patient preference precludes operation. Until better preoperative biomarkers main duct-involved available, it our recommendation that all fit should undergo entire involved segment appropriate adjustment extension based intraoperative pathology. Total pancreatectomy may be indicated diffuse duct involvement. more difficult debated cohort (i.e., side branch disease only), a strategic whether resect appropriate. Patients cytopathology, concerning radiologic features mural nodules, associated mass), symptoms attributable offered resection. Importantly, specific variable importance terms worth characterizing individual patients. Size alone not determining factor resection, although we acknowledge literature unclear this regard. (or any other cystic lesion) nononcologic indication symptom control when size anticipated growth complicate ability safely extirpate lesion. Other factors considered number lesions, need prolonged surveillance, inability perform noninvasive (e.g., contraindication MRI), difficulty (extensive/diffuse multifocal disease), tolerance risk. The decision undergoing primary secondary similar indications noted previously. regimen, however, unknown. regimen depends timing incidence "recurrence" "new metachronous IPMIN development," which fully understood, partly because suboptimal imaging IPMNs. To solve mystery, surgeons pancreatologists encouraged obtain timely studies before taking operating room. followed least annually history physical cross-sectional imaging. Endoscopy cytopathologic assessment biannually often radiographic features. interval decreased extent testing increased higher stratification. Although currently follows same algorithm as pancreatic after segmental (particularly pancreaticoduodenectomy) complicated. new data continue clarify how total many questions remain unanswered. Continued efforts uncover accurate natural behavior fill gaps current understanding practice. meantime, critical educate frequently restratify (history radiographic, endoscopic, results) rigorous follow-up guide reaching