Postoperative Surveillance of Main Duct IPMN

Abstract

Surveillance schedule after resection of main duct IPMNs (MD-IPMNs) is determined based on pathological grade and surgical margin status. Prognosis after resection of invasive IPMNs is better than that of conventional pancreatic ductal adenocarcinomas (PDACs) in the matched status of T1 or N0, or the subtype of colloid carcinoma, while it is not different from that of PDACs in the other conditions (T2 to T4, N1, or other subtypes of carcinoma). Thus, the patients with invasive MD-IPMNs should be basically surveyed according to the protocol of the PDACs. In noninvasive IPMNs (low- to intermediate-grade dysplasia), if there is no residual lesion in the remnant pancreas with negative surgical margin, then the patients might be surveyed at 2 and 5 years after operation to check the development of new lesions in the remnant pancreas. In the patients having positive surgical margin of low- to intermediate-grade dysplasia, the surveillance of twice a year using physical examination and magnetic resonance imaging (MRI) might be suitable, although there has been no evidence regarding the effect of this protocol. On the other hand, it remains unclear whether this surveillance protocol of twice a year would be also applied to the patients after resection for noninvasive carcinoma (high-grade dysplasia). If there are some clinical signs to suspect the progression of the diseases in such patients, then surveillance with shorter interval is recommended.