Timing of Resection of Branch Duct IPMN

Abstract

Branch duct intraductal papillary mucinous neoplasms (IPMNs) carry a moderate risk of malignancy, making resection a possible treatment. However, the annual risk of malignancy is only 2–3 % per year and these slow-growing lesions occur mainly in males during their seventh decade of life, who have relatively short life expectancy. Moreover, since surgery is accompanied by a relatively high morbidity rate and function loss, resection may not be indicated in some patients. Factors found to predict the risk of malignancy include size >3 cm; the presence of mural nodules, main duct dilatation (>5 mm), and cyst wall thickening; growth rate, cytology (+), and the presence of tumor markers. Factors that should be considered in deciding whether to perform surgery include age and life expectancy, whether the general condition of the patient is sufficient for major surgery, patient desire for cure, and tumor location. The complexity of making decisions in regard to patients with BD-IPMN has precluded the development of standard treatment guidelines applicable to every patient. Rather, treatment must be tailored to the clinical situations of individual patients.