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Digestive Disease Interventions
DOI: 10.1055/s-0045-1807272
Invited Article

Intraductal Papillary Mucinous Neoplasm of the Pancreas: An Overview of Surgical Management

João Pedro Gonçalves Kasakewitch
1   Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Kaique Flavio Xavier Cardoso Filardi
1   Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Scott C. Fligor
1   Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Tara Sotsky Kent 
1   Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Funding USAID Cooperative Agreement: AID-440-A-16-00002. Improving Access, Curriculum and Teaching in Medical education and Emerging Diseases (IMPACT MED) Alliance.
› Further Information
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Abstract

Intraductal papillary mucinous neoplasms (IPMNs) are commonly identified cystic lesions in the pancreas that may carry malignant potential for pancreatic ductal adenocarcinoma. Risk stratification of identified lesions is critical to determine which patients may benefit from surgical resection. Key high-risk features include size, growth, main pancreatic duct involvement, obstructive jaundice, and enhancing solid components on imaging. The surgical technique of choice depends on IPMN location, with pancreatoduodenectomy being the most common procedure due to the high incidence of high-risk IPMNs in the head of the pancreas. The extent of resection is guided by imaging and/or endoscopic data, potentially including intraoperative frozen section analysis to assess for high-grade dysplasia or invasive IPMN. Postoperative surveillance of the remnant gland is crucial and based on the risk of disease recurrence after the surgery, which is determined by the anatomopathological report.

Keywords

pancreatic cystic neoplasms - pancreatic cancer - intraductal papillary mucinous neoplasm - pancreatic adenocarcinoma - pancreatic surgery


Publication History

Received: 21 October 2024

Accepted: 13 March 2025

Article published online:
28 April 2025

© 2025. Thieme. All rights reserved.

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