Current Considerations in Nonoperative Surveillance of Intraductal Papillary Mucinous Neoplasms

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

• References

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