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A Clinical Guide to the Management of Intraductal Papillary Mucinous Neoplasms: the Need for a More Graded Approach in Clinical Decision-making

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Intraductal papillary mucinous neoplasms (IPMNs) have become a very common diagnosis and represent a spectrum of disease that ranges from benign to malignant lesions. Presently, clinical and radiographic features are used to predict the presence of high-grade dysplasia and invasive cancer to inform treatment decisions of whether to pursuit surgical resection or continued surveillance. However, the natural history of IPMNs is still not completely understood, with guidelines from different societies providing contradictory recommendations. This underscores the challenge in balancing the risk of missing cancer with long-term surveillance and the morbidity associated with surgical resection. In this review, we aim to reconcile the differences in the guidelines’ recommendations and provide a clinical framework to the management of IPMNs with hopes of adding clarity to how treatment decisions should be made. We also highlight recent advances made in the field and future efforts that can minimize rates of missing cancer while also reducing the number of unnecessary operations.

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Authors and Affiliations

  1. Department of Surgery, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114-3117, USA

    Zhi Ven Fong & Carlos Fernández-del Castillo

  2. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

    Yasmin G. Hernandez-Barco

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  1. Zhi Ven Fong
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  2. Yasmin G. Hernandez-Barco
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  3. Carlos Fernández-del Castillo
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Correspondence to Carlos Fernández-del Castillo.

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Fong, Z.V., Hernandez-Barco, Y.G. & Castillo, C.Fd. A Clinical Guide to the Management of Intraductal Papillary Mucinous Neoplasms: the Need for a More Graded Approach in Clinical Decision-making. J Gastrointest Surg 27, 1988–1998 (2023). https://doi.org/10.1007/s11605-022-05536-1

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