Intraductal papillary mucinous neoplasms of the pancreas.

BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a new pathological entity. It is diagnosed with increasing frequency. However, its natural history and management are still not well defined.
METHODS: A Medline search was undertaken to identify articles using the keywords "intraductal papillary mucinous neoplasms of pancreas", "pancreatic neoplasms", and "pancreatic cyst". Additional papers were identified by a manual search of the references from the key articles.
RESULTS: Surgical resection is the only treatment which can produce a cure. The reported overall 5-year survival for IPMN after surgical resection varies from 36% to 77%; for non-invasive IPMN, 77% to 100% and for invasive IPMN, 27% to 60%. The overall recurrence rate was 7% to 43%. IPMN can recur either as disseminated disease or as isolated pancreatic remnant recurrence even after surgical resection with negative margins.
CONCLUSIONS: Based on the available evidence, patients with IPMN should undergo complete surgical resection. The extent of pancreatic resection and the intra-operative management of resection margins remain controversial. Balancing the risk of recurrence and the morbidity of total pancreatectomy, routine total pancreatectomy for IPMN is not recommended. Total pancreatectomy should only be reserved for patients with resectable but extensive IPMN which involves the whole pancreas. Regular monitoring for disease recurrence is important after surgery as there is a risk of recurrence in both non-invasive and invasive IPMN, and repeat resection for an isolated recurrence in the pancreatic remnant gives good results.