Observation or resection of pancreatic intraductal papillary mucinous neoplasm: An ongoing tug of war

Abstract

An increasing number of patients are being referred to pancreatic centres around the world due to often incidentally discovered cystic neoplasms of the pancreas. The evaluation and management of pancreatic cystic neoplasms is a controversial topic and with existing guidelines based on a lack of strong evidence there is discordance between centres and guidelines with regard to when to offer surgery and when to favour surveillance. The frequency, duration and modality of surveillance is also controversial as this is resource-consuming and must be balanced against the perceived benefits and risks involved. While there is consensus that the risk of malignancy should be balanced against the life-expectancy and comorbidities, the indications for surgery and surveillance strategies vary among the guidelines. Thus, the tug of war between surveillance or resection continues. Here we discuss the recommendations from guidelines with further accumulating data and emerging reports on intraductal papillary mucinous neoplasm in the literature.

A retrospective study of histological outcome for IPMN after surgery in Lausanne, Switzerland: A case series

“…Some surgical teams have proposed an interesting decision tree regarding a specific Asian population [ [39] , [40] , [41] ], and in 2019 Tanaka et al summarized all nine actual recommendations published in the recent English literature [ 42 ]. The last five years, many recommendations gave specific resection criteria, surgical indications, surveillance intervals and modalities for non-suspicious IPMN [ 8 , 38 , [43] , [44] , [45] ]. It appears that the decision making between surgical approach or surveillance is still a matter of debate and the endpoint of this reflection is the balance between patient fitness, moderns imaging system, endoscopic ultrasound, tumor markers with cytology and immunohistochemical analysis of samples.…”

A mixed-type intraductal papillary mucinous neoplasm of the pancreas with a histologic combination of gastric and pancreatobiliary subtypes in a 70-year-old woman: a case report

“…Furthermore, postoperative complications like pancreatic fistula are commonly noticed. Thus, regional pancreatectomy as a curative procedure is the main challenge, and researchers have discussed frozen section analysis as an important component of the surgery [18,19]. Thus, it is crucial to select the ideal procedure for non-invasive IPMNs considering short-and long-term results, in addition to postoperative complications.…”

Analyzing and predicting the LNM rate and prognosis of patients with intraductal papillary mucinous neoplasm of the pancreas

“…In addition, as for the survival of IPMN, according to the malignance which could be identified by the pathological grade and tumor size, the overall 5‐year survival rate are 29%–92% 9 . The existing guidelines such as International Association of Pancreatotomy (IAP) guidelines, European Study Group on Cystic Tumors of the Pancreas and American Gastroenterological Association (AGA) clinical guideline were controversial regarding to the evaluation and management of IPMN 10,11 . For instance, when and to whom surgery should be offered and when to favor surveillance was different 12 .…”

“…The existing guidelines such as International Association of Pancreatotomy (IAP) guidelines, European Study Group on Cystic Tumors of the Pancreas and American Gastroenterological Association (AGA) clinical guideline were controversial regarding to the evaluation and management of IPMN 10,11 . For instance, when and to whom surgery should be offered and when to favor surveillance was different 12 . The frequency, duration, and modality of surveillance is also controversial, as this strategy is resource‐consuming and must be balanced against the perceived benefits and risks involved 12 …”

“…For instance, when and to whom surgery should be offered and when to favor surveillance was different 12 . The frequency, duration, and modality of surveillance is also controversial, as this strategy is resource‐consuming and must be balanced against the perceived benefits and risks involved 12 13 it is a consensus to have correct management to prevent progression into pancreatic cancer for IPMN, moreover, it could reduce the related cost and promote survival.…”