The diagnosis of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) has been dramatically increased. BD-IPMNs are frequently discovered as incidental findings in asymptomatic individuals, mainly in elderly patients. An accurate evaluation of BD-IPMNs with high-resolution imaging techniques and endoscopic ultrasound is necessary. Patients with high-risk stigmata (HRS, obstructive jaundice, enhanced solid component) should undergo resection. Patients with worrisome features (WF, cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, and clinical acute pancreatitis) may undergo either a strict surveillance based on patients' characteristics (age, comorbidities) or surgical resection. Non-operative management is indicated for BD-IPMNs without HRS and WF. Patients with BD-IPMN who do not undergo resection may develop malignant change over time as well as IPMN-distinct pancreatic cancer. However, non-operative management of BD-IPMNs lacking WF and HRS is safe and the risk of malignant degeneration seems relatively low. The optimal surveillance protocol is currently unclear.
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Article Synopsis
- A study was conducted on patients who had surgery for high-risk intraductal papillary mucinous neoplasms (IPMNs) that included a mural module, focusing on the relationship between dysplasia grade and the mural module location.
- The research involved 82 patients, revealing that nearly half had high-grade dysplasia or invasive carcinoma away from the mural module, indicating that local treatment might not be safe or effective.
- The results suggest that pancreatectomy (removal of part or all of the pancreas) remains the best treatment option due to the potential risks associated with localized treatments.
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