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Digestive Disease Interventions
DOI: 10.1055/s-0045-1802658
Review Article

Current Considerations in Nonoperative Surveillance of Intraductal Papillary Mucinous Neoplasms

Mackenzie M. Mayhew
1   Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
,
Ross C.D. Buerlein
2   Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia
,
Victor M. Zaydfudim 
1   Section of Hepatobiliary and Pancreatic Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
› Author Affiliations Funding This project was supported in part by T32 CA163177 from the National Cancer Institute to M.M.M.
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Abstract

Intraductal papillary mucinous neoplasms (IPMNs) account for the majority of incidentally found pancreatic cystic neoplasms. There are three general subtypes: main-duct (MD-IPMN), branch-duct (BD-IPMN), and mixed-type (MT-IPMN) which all carry varying degrees of malignant potential. The malignant risk of IPMN involving the main pancreatic duct ranges from 40 to 80% for both MD-IPMN and MT-IPMN, while the malignancy risk for BD-IPMN is more variable but considered to be much lower. The management of BD-IPMN is typically nonoperative surveillance and remains a topic of debate. In this overview, we discuss the current controversies in the management of BD-IPMN such as the comparison of surveillance strategies based on consensus guidelines, perceived weight of various worrisome features, and/or high-risk stigmata (HRS) features in assessing patient risk for cancer progression, molecular analyses, multifocality, cost-effectiveness strategies, and patient factors considered high-risk for resection. This overview should provide a glimpse into the current state and controversies in the care of patients with nonoperative surveillance of patients with IPMN.

Keywords

pancreatic cancer - pancreatoduodenectomy - side branch


Publication History

Received: 28 September 2024

Accepted: 14 January 2025

Article published online:
06 February 2025

© 2025. Thieme. All rights reserved.

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