Surgical Management of IPMN

  • Stefano Crippa
  • Carlos Fernandez-del Castillo
  • Andrew L. Warshaw
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Once considered as a “rare” entity, intraductal papillary mucinous neoplasm (IPMN) of the pancreas is nowadays more commonly recognized, thanks to the widespread use of cross-sectioning imaging techniques (1, 2). At our institution, IPMN has become the second most common indication for pancreatic resection, following ductal adenocarcinoma.

Since its first description by Ohashi in 1982, knowledge of the clinical, radiologic, and pathologic characteristics of IPMN has increased rapidly ( 3 ). Several series have documented the prevalence of malignancy and the risk of tumor recurrence after surgical resection among these patients. However, much of the natural history of IPMN still remains unknown.

In 2000 the World Health Organization (WHO) divided IPMN into two different entities: main-duct and branch-duct IPMN. Main-duct IPMNs are characterized by involvement of the main pancreatic duct with or without associated involvement of the branch ducts (combined IPMNs) ( 2 ). They commonly present with a dilated (≤1 cm) main pancreatic duct full of mucus that may extrude through a bulging ampulla. Some have cystic dilation of the main pancreatic duct ( 4 ). Main-duct IPMNs are usually located in the proximal portion of the gland, but can spread longitudinally along the duct, even to involve the entire main pancreatic duct. Patients affected by main-duct IPMN may present with abdominal pain, pancreatitis, steatorrhea, and weight loss. Diabetes is indicative of late-stage deterioration, and jaundice commonly indicates malignant degeneration ( 58 ).


Main Pancreatic Duct Intraductal Papillary Mucinous Neoplasm Total Pancreatectomy Main Duct Mural Nodule 
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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Stefano Crippa
    • 1
  • Carlos Fernandez-del Castillo
    • 1
  • Andrew L. Warshaw
    • 1
  1. 1.Harvard Medical SchoolMassachusetts General HospitalBostonUSA

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