- Overview of US, European, and international guidelines on treatment and/or surveillance for mucinous cystic neoplasms (MCN) and intraductal papillarymucinous neoplasms (IPMN).
Why this matters
- Pancreatic cyst neoplasms are heterogeneous and increasingly being discovered during routine cross-sectional imaging, presenting clinicians with the dilemma of how to balance cancer prevention with the risk for surgical overtreatment.
- Most pancreatic cysts are benign, but some can develop into pancreatic cancer.
- Revised guidelines suggest that the following characteristics are absolute indications for resection in patients with IPMN:
- obstructive jaundice,
- a contrast-enhanced mural nodule or solid component ≥5 mm,
- a dilated pancreatic duct, and
- positive cytology for advanced neoplasia.
- European guidelines suggest conservative treatment of an MCN and IPMN
- International and US guidelines suggest any MCN is an absolute indication of resection. International guidelines suggest IPMN >30 mm is a relative indication for resection.
- Patients with IPMN and MCN should undergo lifelong surveillance as long as they are willing and able to undergo surgery if needed.
- Patients with IPMN should be followed-up after pancreatectomy because of risk of recurrence. The optimal surveillance interval has not been determined.