Skip to main content

Advertisement

SpringerLink
Log in

IPMN: surgical treatment

  • Review Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Cystic pancreatic tumors are being detected more frequently, and particularly, intraductal papillary mucinous neoplasia (IPMN) has recently attracted increased attention. The detection rate of IPMN has increased over the last decade; however, management of this neoplasm remains controversial.

Methods

Based on a review of the relevant literature and the international guidelines, we discuss the diagnostic evaluation of IPMN, its treatment, and prognosis.

Results

While IPMN represents only a distinct minority of all pancreatic cancers, they appear to be a relatively frequent neoplastic form of pancreatic cystic neoplasm. It may not be possible to differentiate main duct disease from branch duct disease (MD-IPMN vs. BD-IPMN) prior to surgery. This distinction has not only an impact on treatment but also on prognosis, as MD-IPMN is more often malignant. IPMN has updated consensus guideline indications for conservative and surgical resection.

Conclusions

Since patients with IPMN of the pancreas are at risk of developing recurrent IPMN and pancreatic ductal adenocarcinoma in the remnant pancreas and extrapancreatic malignancies, early recognition, treatment, and systemic surveillance are of great importance. No conclusions can be drawn from the available evidence with respect to the efficacy of surveillance and follow-up treatment programs. A better understanding of the natural course of IPMN and the biology of pancreatic cancer is mandatory to enable further diagnostic and treatment improvements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ban S, Naitoh Y, Mino-Kenudson M, Sakurai T, Kuroda M, Koyama I, Lauwers GY, Shimizu M (2006) Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: its histopathologic difference between 2 major types. Am J Surg Pathol 30(12):1561–1569

    Article  PubMed  Google Scholar 

  2. Tanaka M, Chari S, Adsay V, Fernandez-del Castillo C, Falconi M, Shimizu M, Yamaguchi K, Yamao K, Matsuno S, International Association of Pancreatology (2006) International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology 6(1–2):17–32

    Article  PubMed  Google Scholar 

  3. Adsay NV (2008) Cystic neoplasia of the pancreas: pathology and biology. J Gastrointest Surg 12(3):401–404

    Article  PubMed  Google Scholar 

  4. Salvia R, Fernández-del Castillo C, Bassi C, Thayer SP, Falconi M, Mantovani W, Pederzoli P, Warshaw AL (2004) Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg 239(5):678–685, discussion 685–687

    Article  PubMed  Google Scholar 

  5. Rodriguez JR, Salvia R, Crippa S, Warshaw AL, Bassi C, Falconi M, Thayer SP, Lauwers GY, Capelli P, Mino-Kenudson M, Razo O, McGrath D, Pederzoli P, Fernández-Del Castillo C (2007) Branch-duct intraductal papillary mucinous neoplasms: observations in 145 patients who underwent resection. Gastroenterology 133(1):72–79

    Article  PubMed  Google Scholar 

  6. De Jong K, Nio CY, Hermans JJ, Dijkgraaf MG, Gouma DJ, van Eijck CHJ, van Heel E, Klass G, Fockens P, Bruno MJ (2010) High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 8(9):806–811

    Article  PubMed  Google Scholar 

  7. Ferrone CR, Correa-Gallego C, Warshaw AL, Brugge WR, Forcione DG, Thayer SP, Fernández-del Castillo C (2009) Current trends in pancreatic cystic neoplasms. Arch Surg 144(5):448–454

    Article  PubMed  Google Scholar 

  8. Ip IK, Mortele KJ, Prevedello LM, Khorasani R (2011) Focal cystic pancreatic lesions: assessing variation in radiologists’ management recommendations. Radiology 259(1):136–141

    Article  PubMed  Google Scholar 

  9. Cameron JL, Riall TS, Coleman J, Belcher KA (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244(1):10–15

    Article  PubMed  Google Scholar 

  10. Vignesh S, Brugge WR (2008) Endoscopic diagnosis and treatment of pancreatic cysts. J Clin Gastroenterol 42(5):493–506

    Article  PubMed  Google Scholar 

  11. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10(9):1199–1210, discussion 1210–1211

    Article  PubMed  Google Scholar 

  12. Bassi C, Sarr MG, Lillemoe KD, Reber HA (2008) Natural history of intraductal papillary mucinous neoplasms (IPMN): current evidence and implications for management. J Gastrointest Surg 12(4):645–650

    Article  PubMed  Google Scholar 

  13. Del Chiaro M, Verbeke C, Salvia R, Klöppel G, Werner J, McKay C, Friess H, Manfredi R, Van Cutsem E, Löhr M, Segersvärd R; the European Study Group on Cystic Tumours of the Pancreas (2013) European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013

  14. Werner J, Fritz S, Büchler MW (2012) Intraductal papillary mucinous neoplasms of the pancreas--a surgical disease. Nat Rev Gastroenterol Hepatol 9(5):253–259

    Article  PubMed  CAS  Google Scholar 

  15. Tanaka M, Fernández-del Castillo C, Adsay V, Chari S, Falconi M, Jang J-Y, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K, International Association of Pancreatology (2012) International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 12(3):183–197

    Article  PubMed  Google Scholar 

  16. Furukawa T, Hatori T, Fujita I, Yamamoto M, Kobayashi M, Ohike N, Morohoshi T, Egawa S, Unno M, Takao S, Osako M, Yonezawa S, Mino-Kenudson M, Lauwers GY, Yamaguchi H, Ban S, Shimizu M (2011) Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut 60(4):509–516

    Article  PubMed  Google Scholar 

  17. Hruban RH, Maitra A, Kern SE, Goggins M (2007) Precursors to pancreatic cancer. Gastroenterol Clin North Am 36(4):831–849, vi

    Article  PubMed  Google Scholar 

  18. Klibansky DA, Reid-Lombardo KM, Gordon SR, Gardner TB (2012) The clinical relevance of the increasing incidence of intraductal papillary mucinous neoplasm. Clin Gastroenterol Hepatol 10(5):555–558

    Article  PubMed  Google Scholar 

  19. Tanaka M (2004) Intraductal papillary mucinous neoplasm of the pancreas: diagnosis and treatment. Pancreas 28(3):282–288

    Article  PubMed  Google Scholar 

  20. Grützmann R, Post S, Saeger HD, Niedergethmann M (2011) Intraductal papillary mucinous neoplasia (IPMN) of the pancreas: its diagnosis, treatment, and prognosis. Dtsch Arzteblatt Int 108(46):788–794

    Google Scholar 

  21. Sarr MG, Murr M, Smyrk TC, Yeo CJ, Fernandez-del-Castillo C, Hawes RH, Freeny PC (2003) Primary cystic neoplasms of the pancreas. Neoplastic disorders of emerging importance-current state-of-the-art and unanswered questions. J Gastrointest Surg 7(3):417–428

    Article  PubMed  Google Scholar 

  22. Niedergethmann M, Grützmann R, Hildenbrand R, Dittert D, Aramin N, Franz M, Dobrowolski F, Post S, Saeger HD (2008) Outcome of invasive and noninvasive intraductal papillary-mucinous neoplasms of the pancreas (IPMN): a 10-year experience. World J Surg 32(10):2253–2260

    Article  PubMed  Google Scholar 

  23. Sugiyama M, Izumisato Y, Abe N, Masaki T, Mori T, Atomi Y (2003) Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 90(10):1244–1249

    Article  PubMed  CAS  Google Scholar 

  24. Pelaez-Luna M, Chari ST, Smyrk TC, Takahashi N, Clain JE, Levy MJ, Pearson RK, Petersen BT, Topazian MD, Vege SS, Kendrick M, Farnell MB (2007) Do consensus indications for resection in branch duct intraductal papillary mucinous neoplasm predict malignancy? A study of 147 patients. Am J Gastroenterol 102(8):1759–1764

    Article  PubMed  Google Scholar 

  25. Das A, Wells CD, Nguyen CC (2008) Incidental cystic neoplasms of pancreas: what is the optimal interval of imaging surveillance? Am J Gastroenterol 103(7):1657–1662

    Article  PubMed  Google Scholar 

  26. Fernández-del Castillo C, Targarona J, Thayer SP, Rattner DW, Brugge WR, Warshaw AL (2003) Incidental pancreatic cysts: clinicopathologic characteristics and comparison with symptomatic patients. Arch Surg 138(4):427–423, discussion 433–434

    Article  PubMed  Google Scholar 

  27. Berland LL, Silverman SG, Gore RM, Mayo-Smith WW, Megibow AJ, Yee J, Brink JA, Baker ME, Federle MP, Foley WD, Francis IR, Herts BR, Israel GM, Krinsky G, Platt JF, Shuman WP, Taylor AJ (2010) Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 7(10):754–773

    Article  PubMed  Google Scholar 

  28. Crippa S, Partelli S, Falconi M (2010) Extent of surgical resections for intraductal papillary mucinous neoplasms. World J Gastrointest Surg 2(10):347–351

    Article  PubMed  Google Scholar 

  29. Manfredi R, Graziani R, Motton M, Mantovani W, Baltieri S, Tognolini A, Crippa S, Capelli P, Salvia R, Pozzi Mucelli R (2009) Main pancreatic duct intraductal papillary mucinous neoplasms: accuracy of MR imaging in differentiation between benign and malignant tumors compared with histopathologic analysis. Radiology 253(1):106–115

    Article  PubMed  Google Scholar 

  30. Ohno E, Hirooka Y, Itoh A, Ishigami M, Katano Y, Ohmiya N, Niwa Y, Goto H (2009) Intraductal papillary mucinous neoplasms of the pancreas: differentiation of malignant and benign tumors by endoscopic ultrasound findings of mural nodules. Ann Surg 249(4):628–634

    Article  PubMed  Google Scholar 

  31. Yamao K, Nakamura T, Suzuki T, Sawaki A, Hara K, Kato T, Okubo K, Matsumoto K, Shimizu Y (2003) Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 10(2):142–146

    Article  PubMed  Google Scholar 

  32. Waters JA, Schmidt CM, Pinchot JW, White PB, Cummings OW, Pitt HA, Sandrasegaran K, Akisik F, Howard TJ, Nakeeb A, Zyromski NJ, Lillemoe KD (2008) CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 12(1):101–109

    Article  PubMed  Google Scholar 

  33. Salvia R, Crippa S, Falconi M, Bassi C, Guarise A, Scarpa A, Pederzoli P (2007) Branch-duct intraductal papillary mucinous neoplasms of the pancreas: to operate or not to operate? Gut 56(8):1086–1090

    Article  PubMed  Google Scholar 

  34. Park WG-U, Mascarenhas R, Palaez-Luna M, Smyrk TC, O’Kane D, Clain JE, Levy MJ, Pearson RK, Petersen BT, Topazian MD, Vege SS, Chari ST (2011) Diagnostic performance of cyst fluid carcinoembryonic antigen and amylase in histologically confirmed pancreatic cysts. Pancreas 40(1):42–45

    Article  PubMed  CAS  Google Scholar 

  35. Brugge WR, Lauwers GY, Sahani D, Fernandez-del Castillo C, Warshaw AL (2004) Cystic neoplasms of the pancreas. N Engl J Med 351(12):1218–1226

    Article  PubMed  CAS  Google Scholar 

  36. Correa-Gallego C, Warshaw AL, Fernandez-del Castillo C (2009) Fluid CEA in IPMNs: a useful test or the flip of a coin? Am J Gastroenterol 104(3):796–797

    Article  PubMed  Google Scholar 

  37. Genevay M, Mino-Kenudson M, Yaeger K, Konstantinidis IT, Ferrone CR, Thayer S, Castillo CF, Sahani D, Bounds B, Forcione D, Brugge WR, Pitman MB (2011) Cytology adds value to imaging studies for risk assessment of malignancy in pancreatic mucinous cysts. Ann Surg 254(6):977–983

    Article  PubMed  Google Scholar 

  38. Cizginer S, Turner BG, Turner B, Bilge AR, Karaca C, Pitman MB, Brugge WR (2011) Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 40(7):1024–1028

    Article  PubMed  CAS  Google Scholar 

  39. Sedlack R, Affi A, Vazquez-Sequeiros E, Norton ID, Clain JE, Wiersema MJ (2002) Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc 56(4):543–547

    Article  PubMed  Google Scholar 

  40. Pitman MB, Michaels PJ, Deshpande V, Brugge WR, Bounds BC (2008) Cytological and cyst fluid analysis of small (< or =3 cm) branch duct intraductal papillary mucinous neoplasms adds value to patient management decisions. Pancreatology 8(3):277–284

    Article  PubMed  Google Scholar 

  41. Fritz S, Hackert T, Hinz U, Hartwig W, Büchler MW, Werner J (2011) Role of serum carbohydrate antigen 19–9 and carcinoembryonic antigen in distinguishing between benign and invasive intraductal papillary mucinous neoplasm of the pancreas. Br J Surg 98(1):104–110

    Article  PubMed  CAS  Google Scholar 

  42. Correa-Gallego C, Ferrone CR, Thayer SP, Wargo JA, Warshaw AL, Fernández-Del Castillo C (2010) Incidental pancreatic cysts: do we really know what we are watching? Pancreatology 10(2–3):144–150

    Article  PubMed  Google Scholar 

  43. Oh H-C, Kim M-H, Hwang CY, Lee TY, Lee SS, Seo D-W, Lee SK (2008) Cystic lesions of the pancreas: challenging issues in clinical practice. Am J Gastroenterol 103(1):229–239

    Article  PubMed  Google Scholar 

  44. Goh BKP, Ooi LLPJ, Kumarasinghe MP, Tan Y-M, Cheow P-C, Chow PKH, Chung YF, Wong WK (2006) Clinicopathological features of patients with concomitant intraductal papillary mucinous neoplasm of the pancreas and pancreatic endocrine neoplasm. Pancreatology 6(6):520–526

    Article  PubMed  Google Scholar 

  45. Kim SY, Lee JM, Kim SH, Shin K-S, Kim YJ, An SK, Han CJ, Han JK, Choi BI (2006) Macrocystic neoplasms of the pancreas: CT differentiation of serous oligocystic adenoma from mucinous cystadenoma and intraductal papillary mucinous tumor. Ajr Am J Roentgenol 187(5):1192–1198

    Article  PubMed  Google Scholar 

  46. Sohn TA, Yeo CJ, Cameron JL, Hruban RH, Fukushima N, Campbell KA, Lillemoe KD (2004) Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg 239(6):788–797, discussion 797–799

    Article  PubMed  Google Scholar 

  47. Takahashi H, Nakamori S, Nakahira S, Tsujie M, Takahshi Y, Marubashi S, Miyamoto A, Takeda Y, Nagano H, Dono K, Umeshita K, Sakon M, Monden M (2006) Surgical outcomes of noninvasive and minimally invasive intraductal papillary-mucinous neoplasms of the pancreas. Ann Surg Oncol 13(7):955–960

    Article  PubMed  Google Scholar 

  48. Maguchi H, Tanno S, Mizuno N, Hanada K, Kobayashi G, Hatori T, Sadakari Y, Yamaguchi T, Tobita K, Doi R, Yanagisawa A, Tanaka M (2011) Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas 40(3):364–370

    Article  PubMed  Google Scholar 

  49. Nagai K, Doi R, Kida A, Kami K, Kawaguchi Y, Ito T, Sakurai T, Uemoto S (2008) Intraductal papillary mucinous neoplasms of the pancreas: clinicopathologic characteristics and long-term follow-up after resection. World J Surg 32(2):271–278, discussion 279–280

    Article  PubMed  Google Scholar 

  50. Walsh RM, Vogt DP, Henderson JM, Hirose K, Mason T, Bencsath K, Hammel J, Brown N (2008) Management of suspected pancreatic cystic neoplasms based on cyst size. Surgery 144(4):677–684, discussion 684–685

    Article  PubMed  Google Scholar 

  51. Schmidt CM, White PB, Waters JA, Yiannoutsos CT, Cummings OW, Baker M, Howard TJ, Zyromski NJ, Nakeeb A, DeWitt JM, Akisik FM, Sherman S, Pitt HA, Lillemoe KD (2007) Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg 246(4):644–651

    Article  PubMed  Google Scholar 

  52. Tanno S, Nakano Y, Sugiyama Y, Nakamura K, Sasajima J, Koizumi K, Yamazaki M, Nishikawa T, Mizukami Y, Yanagawa N, Fujii T, Obara T, Okumura T, Kohgo Y (2010) Incidence of synchronous and metachronous pancreatic carcinoma in 168 patients with branch duct intraductal papillary mucinous neoplasm. Pancreatology 10(2–3):173–178

    Article  PubMed  Google Scholar 

  53. Tanno S, Nakano Y, Nishikawa T, Nakamura K, Sasajima J, Minoguchi M, Mizukami Y, Yanagawa N, Fujii T, Obara T, Okumura T, Kohgo Y (2008) Natural history of branch duct intraductal papillary-mucinous neoplasms of the pancreas without mural nodules: long-term follow-up results. Gut 57(3):339–343

    Article  PubMed  CAS  Google Scholar 

  54. Fritz S, Klauss M, Bergmann F, Hackert T, Hartwig W, Strobel O, Bundy BD, Büchler MW, Werner J (2012) Small (Sendai negative) branch-duct IPMNs: not harmless. Ann Surg 256(2):313–320

    Article  PubMed  Google Scholar 

  55. Jang J-Y, Kim S-W, Lee SE, Yang SH, Lee KU, Lee YJ, Kim SC, Han DJ, Choi DW, Choi SH, Heo JS, Cho BH, Yu HC, Yoon DS, Lee WJ, Lee HE, Kang GH, Lee JM (2008) Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol 15(1):199–205

    Article  PubMed  Google Scholar 

  56. Weinberg BM, Spiegel BMR, Tomlinson JS, Farrell JJ (2010) Asymptomatic pancreatic cystic neoplasms: maximizing survival and quality of life using Markov-based clinical nomograms. Gastroenterology 138(2):531–540

    Article  PubMed  Google Scholar 

  57. Sawai Y, Yamao K, Bhatia V, Chiba T, Mizuno N, Sawaki A, Takahashi K, Tajika M, Shimizu Y, Yatabe Y, Yanagisawa A (2010) Development of pancreatic cancers during long-term follow-up of side-branch intraductal papillary mucinous neoplasms. Endoscopy 42(12):1077–1084

    Article  PubMed  CAS  Google Scholar 

  58. Kang MJ, Jang J-Y, Kim SJ, Lee KB, Ryu JK, Kim Y-T, Yoon YB, Kim SW (2011) Cyst growth rate predicts malignancy in patients with branch duct intraductal papillary mucinous neoplasms. Clin Gastroenterol Hepatol 9(1):87–93

    Article  PubMed  Google Scholar 

  59. Anand N, Sampath K, Wu BU (2013) Cyst features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Clin Gastroenterol Hepatol 11(8):913–921

    Article  PubMed  Google Scholar 

  60. Arlix A, Bournet B, Otal P, Canevet G, Thevenot A, Kirzin S, Carrere N, Suc B, Moreau J, Escourrou J, Buscail L (2012) Long-term clinical and imaging follow-up of nonoperated branch duct form of intraductal papillary mucinous neoplasms of the pancreas. Pancreas 41(2):295–301

    Article  PubMed  Google Scholar 

  61. Weitz J, Koch M, Kleeff J, Müller MW, Schmidt J, Friess H, Büchler MW (2004) Kausch-Whipple pancreaticoduodenectomy. Technique and results. Chirurg 75(11):1113–1119

    Article  PubMed  CAS  Google Scholar 

  62. Müller SA, Hartel M, Mehrabi A, Welsch T, Martin DJ, Hinz U, Schmied BM, Büchler MW (2009) Vascular resection in pancreatic cancer surgery: survival determinants. J Gastrointest Surg 13(4):784–792

    Article  PubMed  Google Scholar 

  63. Falconi M, Salvia R, Bassi C, Zamboni G, Talamini G, Pederzoli P (2001) Clinicopathological features and treatment of intraductal papillary mucinous tumour of the pancreas. Br J Surg 88(3):376–381

    Article  PubMed  CAS  Google Scholar 

  64. Sugiyama M, Atomi Y (1998) Intraductal papillary mucinous tumors of the pancreas: imaging studies and treatment strategies. Ann Surg 228(5):685–691

    Article  PubMed  CAS  Google Scholar 

  65. Warshaw AL, Rattner DW, Fernández-del Castillo C, Z’graggen K (1998) Middle segment pancreatectomy: a novel technique for conserving pancreatic tissue. Arch Surg 133(3):327–331

    Article  PubMed  CAS  Google Scholar 

  66. Müller MW, Friess H, Kleeff J, Hinz U, Wente MN, Paramythiotis D, Berberat PO, Ceyhan GO, Büchler MW (2006) Middle segmental pancreatic resection: An option to treat benign pancreatic body lesions. Ann Surg 244(6):909–918, discussion 918–920

    Article  PubMed  Google Scholar 

  67. Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, Büchler MW, Werner J (2011) Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbecks Arch Surg 396(8):1197–1203

    Article  PubMed  Google Scholar 

  68. Valsangkar NP, Morales-Oyarvide V, Thayer SP, Ferrone CR, Wargo JA, Warshaw AL, Fernández-del Castillo C (2012) 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery 152(3 Suppl 1):S4–S12

    Article  PubMed  Google Scholar 

  69. Hartwig W, Hackert T, Hinz U, Gluth A, Bergmann F, Strobel O, Büchler MW, Werner J (2011) Pancreatic cancer surgery in the new millennium: better prediction of outcome. Ann Surg 254(2):311–319

    Article  PubMed  Google Scholar 

  70. Mizuta Y, Akazawa Y, Shiozawa K, Ohara H, Ohba K, Ohnita K, Isomoto H, Takeshima F, Omagari K, Tanaka K, Yasutake T, Nakagoe T, Shirono K, Kohno S (2005) Pseudomyxoma peritonei accompanied by intraductal papillary mucinous neoplasm of the pancreas. Pancreatology 5(4–5):470–474

    Article  PubMed  Google Scholar 

  71. Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, Donohue JH, Farnell MB, Kendrick ML (2010) Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg 145(7):616–621

    Article  PubMed  Google Scholar 

  72. Gumbs AA, Grès P, Madureira FA, Gayet B (2008) Laparoscopic vs. open resection of noninvasive intraductal pancreatic mucinous neoplasms. J Gastrointest Surg 12(4):707–712

    Article  PubMed  Google Scholar 

  73. Farnell MB (2008) Surgical management of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. J Gastrointest Surg 12(3):414–416

    Article  PubMed  Google Scholar 

  74. Jang J-Y, Kim S-W, Ahn YJ, Yoon Y-S, Choi MG, Lee KU, Han JK, Kim WH, Lee YJ, Kim SC, Han DJ, Kim YI, Choi SH, Cho BH, Yu HC, Yoon DS, Lee WJ, Lee KB, Kim YC, Lee KS, Kim MW, Kim HJ, Kim HJ, Park YH (2005) Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann Surg Oncol 12(2):124–132

    Article  PubMed  Google Scholar 

  75. Fernández-del Castillo C, Adsay NV (2010) Intraductal papillary mucinous neoplasms of the pancreas. Gastroenterology 139(3):708–713, 713.e1–2

    Article  PubMed  Google Scholar 

  76. Ohtsuka T, Kono H, Tanabe R, Nagayoshi Y, Mori Y, Sadakari Y, Takahata S, Oda Y, Aishima S, Igarashi H, Ito T, Ishigami K, Nakamura M, Mizumoto K, Tanaka M (2012) Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas. Am J Surg 204(1):44–48

    Article  PubMed  Google Scholar 

  77. He J, Cameron JL, Ahuja N, Makary MA, Hirose K, Choti MA, Schulick RD, Hruban RH, Pawlik TM, Wolfgang CL (2013) Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg 216(4):657–665, discussion 665–667

    Article  PubMed  Google Scholar 

  78. Matthaei H, Norris AL, Tsiatis AC, Olino K, Hong S-M, dal Molin M, Goggins MG, Canto M, Horton KM, Jackson KD, Capelli P, Zamboni G, Bortesi L, Furukawa T, Egawa S, Ishida M, Ottomo S, Unno M, Motoi F, Wolfgang CL, Edil BH, Cameron JL, Eshleman JR, Schulick RD, Maitra A, Hruban RH (2012) Clinicopathological characteristics and molecular analyses of multifocal intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 255(2):326–333

    Article  PubMed  Google Scholar 

  79. Kawakubo K, Tada M, Isayama H, Sasahira N, Nakai Y, Takahara N, Uchino R, Hamada T, Miyabayashi K, Yamamoto K, Mizuno S, Mohri D, Kogure H, Sasaki T, Yamamoto N, Hirano K, Ijichi H, Tateishi K, Koike K (2013) Disease-specific mortality among patients with intraductal papillary mucinous neoplasm of the pancreas. Clin Gastroenterol Hepatol 2013.

  80. Ishida M, Egawa S, Kawaguchi K, Aoki T, Sakata N, Mikami Y, Motoi F, Abe T, Fukuyama S, Katayose Y, Sunamura M, Unno M, Moriya T, Horii A, Furukawa T (2008) Synchronous and metachronous extrapancreatic malignant neoplasms in patients with intraductal papillary-mucinous neoplasm of the pancreas. Pancreatology 8(6):577–582

    Article  PubMed  Google Scholar 

  81. Poultsides GA, Reddy S, Cameron JL, Hruban RH, Pawlik TM, Ahuja N, Jain A, Edil BH, Iacobuzio-Donahue CA, Schulick RD, Wolfgang CL (2010) Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg 251(3):470–476

    Article  PubMed  Google Scholar 

  82. Swartz MJ, Hsu CC, Pawlik TM, Winter J, Hruban RH, Guler M, Schulick RD, Cameron JL, Laheru DA, Wolfgang CL, Herman JM (2010) Adjuvant chemoradiotherapy after pancreatic resection for invasive carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas. Int J Radiat Oncol Biol Phys 76(3):839–844

    Article  PubMed  CAS  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery, Kantonsspital St.Gallen, 9007, St.Gallen, Switzerland

    Reto M. Käppeli, Sascha A. Müller, Bianka Hummel, Christina Kruse, Philip Müller, Alexander Wilhelm, Marcel Zadnikar, Bruno M. Schmied & Ignazio Tarantino

  2. Institute of Radiology, Kantonsspital St.Gallen, 9007, St.Gallen, Switzerland

    Jürgen Fornaro

Authors
  1. Reto M. Käppeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sascha A. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bianka Hummel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christina Kruse
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jürgen Fornaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alexander Wilhelm
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marcel Zadnikar
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bruno M. Schmied
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ignazio Tarantino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bruno M. Schmied.

Additional information

Reto M. Käppeli and Sascha A. Müller contributed equally to this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Käppeli, R.M., Müller, S.A., Hummel, B. et al. IPMN: surgical treatment. Langenbecks Arch Surg 398, 1029–1037 (2013). https://doi.org/10.1007/s00423-013-1106-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-013-1106-1

Keywords

Search

Navigation