IPMN ( intraductal papillary mucinous neoplasm) pancreas

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Pancreatic cystic neoplasms (PCN) are estimated to be present in 2- 45% of the general population (1,2)

  • PCN comprise a clinically challenging entity as their biological behaviour ranges from benign to malignant disease - often difficult to differentiate between the various types of PCN.

Recommendations include conservative management, relative and absolute indications for surgery

  • a conservative approach is recommended for asymptomatic MCN (mucinous cystic neoplasm) and IPMN ( intraductal papillary mucinous neoplasm) measuring <40 mm without an enhancing nodule (1)
    • relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter>=40 mm
      • absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm
      • lifelong follow-up of IPMN is recommended in patients who are fit for surgery

    • MCN measuring <40mm without a mural nodule or symptoms may undergo surveillance with MRI, EUS, or a combination of both
        • for patients with MCN measuring between 30 and 40mm, clinicians can incorporate other factors such as age, comorbidities, patient's surgical risk, and patient preference (1)

    • serous cystic neoplasm (SCN)
      • SCN is a benign entity
        • there are essentially no deaths that are attributable to dissemination/malignant behaviour of an SCN
        • surgical intervention
          • surgery is recommended only in patients with symptoms related to the compression of adjacent organs (ie, bile duct, stomach, duodenum, portal vein)
          • size of about 60% of SCN remains stable - an increase in cyst size is seen in 40% but the rate of growth is slow and new onset of symptoms is very rare (2)

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Last edited 04/2020

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