Surgical Management of IPMN Lesions of the Pancreas
Segmental anatomic pancreatectomy with lymph node dissection is currently the most commonly reported technique for the operative management of intraductal papillary mucinous neoplasm (IPMN). More limited resection (enucleation or central pancreatectomy) may be considered for noninvasive branch-duct IPMN (BD-IPMN) in an effort to minimize the operative risks and postoperative sequelae of endocrine and/or exocrine insufficiency. The optimal operative strategy for extensive multifocal BD-IPMN and diffuse main-duct IPMN is more controversial, because in these circumstances the entire gland may be at equal risk of high-grade dysplasia or microinvasive disease either concurrently or in the future. Although total pancreatectomy may be considered, the long-term complications of this procedure (the apancreatic state) are far greater than after segmental resection. Currently, lifelong surveillance is recommended for patients with IPMN, whether resected (with segmental resection) or not, because of the susceptibility of the whole pancreatic gland to dysplastic change over time.
