title: IPMN: surgical treatment.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Surgery, Kantonsspital St.Gallen, 9007, St.Gallen, Switzerland.
authors.forename: Reto M
authors.initials: RM
authors.lastname: Käppeli
authors.forename: Sascha A
authors.initials: SA
authors.lastname: Müller
authors.forename: Bianka
authors.initials: B
authors.lastname: Hummel
authors.forename: Christina
authors.initials: C
authors.lastname: Kruse
authors.forename: Philip
authors.initials: P
authors.lastname: Müller
authors.forename: Jürgen
authors.initials: J
authors.lastname: Fornaro
authors.forename: Alexander
authors.initials: A
authors.lastname: Wilhelm
authors.forename: Marcel
authors.initials: M
authors.lastname: Zadnikar
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors