Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by papillary growths within the pancreatic ductal system that are at risk for undergoing malignant transformation. Main duct IPMN carries a significant risk of malignancy, and operation is recommended regardless of the presence of symptoms. The risk of malignancy is much lower for side branch IPMN, and current evidence suggests that, in the absence of symptoms, mural nodules, positive cytology, or cyst size less than 3 cm, observation is warranted. When operation is indicated, targeted pancreatic resection with frozen-section analysis of margins is recommended. Pancreatoduodenectomy or distal pacreatectomy is appropriate for the majority. Only in about 10% of patients is the disease so diffuse at presentation that total pancreatectomy is necessary. Survival following pancreatic resection for noninvasive IPMN is excellent. The risk of recurrence following pancreatic resection for invasive IPMN is significant. Surveillance is warranted both for patients subjected to pancreatic resection and for those under observation with side branch IPMN. Much is yet to be learned regarding this neoplasm, and surgical management remains in evolution.