Intraductal papillary mucinous neoplasm of the pancreas; resection and cancer prevention

Surgical indications or method of resection for intraductal papillary mucinous neoplasm of the pancreas (IPMN) are controversial. The aim of the current study was to evaluate surgical indications including cancer prevention and selection of specific surgical procedures. A group of 244 patients who underwent pancreatectomy for IPMN from 1981 to 2005 was examined retrospectively for clinicopathologic features. Carcinomas (carcinoma in situ + invasive carcinoma) were observed in 72% of the patients with main duct IPMN. The mural nodules for patients with carcinomas were larger than 3 mm. The maximum diameter of branch duct IPMN for patients with borderline atypia was larger than 30 mm. Lymph node metastasis and extrapancreatic invasion were observed only in patients with invasive carcinoma. In limited pancreatic resection, pancreatic fistulae were observed in 7.9% of patients. The indication for IPMN resection, including for cancer prevention, is lesions above IPMN with borderline atypia (main duct IPMN, mural nodule ≥3 mm, maximum diameter of branch duct IPMN ≥30 mm). A pancreatectomy with lymph node dissection should be performed for invasive IPMNs and a limited pancreatic resection has a role for noninvasive IPMNs.