Intraductal papillary mucinous neoplasms of the pancreas: A surgical perspective

摘要: Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas represent a relatively "new", but increasingly recognized entity. The emergence this entity is due primarily to widespread use modern imaging methods, also heightened awareness physicians regarding cystic neoplasm pancreas. No signs or symptoms are pathognomonic IPMNs, frequently, patients have pancreatitis-like abdominal pain. Fully one-third with IPMN asymptomatic at time diagnosis. Cross-sectional (ultrasonography, computed tomography, magnetic resonance cholangiopancreatography), endoscopic retrograde cholangiopancreatography, and ultrasonography diagnostic staging methods choice in evaluation IPMNs. IPMNs show wide spectrum histologic changes, ranging from adenoma invasive neoplasm, even within same suggesting "field defect" predisposing major segments entire ductal epithelium development IPMN. Fine-needle aspiration/cytology and/or analysis fluid may be useful tools; however, these examinations associated high false-negative rates. Complete surgical resection therapeutic method choice. extent type pancreatectomy remain somewhat controversial should based on morphologic changes Even role adjuvant therapy remains unclear; being "duct-derived" potential malignant character, some form chemo- ratio-therapy seems indicated presence disease, despite "curative" resection. In absence prognosis after R0 highly favorable recurrences 5-10%. However, behave quite similar adenocarcinoma when analyzed stage-by-stage, slightly better prognosis; an resection, recurrence common.