Management Strategy and Surveillance of Intraductal Papillary Mucinous Neoplasm–Gastroenterologist’s Viewpoint / 대한소화기암학회지

ABSTRACT

The length, the frequency, and the methods of surveillance for intraductal papillary mucinous neoplasm (IPMN) of the pancreas are still debating. According to the recent guidelines, IPMN is stratified into “high-risk stigmata” or absolute indication and “worrisome features” or relative indication as a guide in managing these patients, either those with resection of the lesion or those under surveillance. The risk of malignant transformation was quite low for branch duct-IPMNs without worrisome features or high risk stigmata. However, because the incidence rate of pancreatic cancer in these patients increase linearly with time, continued long-term surveillance is therefore important for patients with low-risk, as well as higher-risk, IPMN.Considering the high prevalence of malignancy, main duct-IPMN should be treated by surgical resection. Among patients with these type IPMNs, segmental dilatation of the main pancreatic duct without any mural nodules and larger than 10 mm of main pancreatic duct might not be immediately resected and need very careful examination and observation. The risk related to a major pancreatic resection must balance the risk of surveillance in patients with IPMN of the pancreas who have co-morbidity and are elderly.