title: Treatment of branch-duct intraductal papillary mucinous neoplasms of the pancreas: state of the art.
abstract: The diagnosis of branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) has been dramatically increased. BD-IPMNs are frequently discovered as incidental findings in asymptomatic individuals, mainly in elderly patients. An accurate evaluation of BD-IPMNs with high-resolution imaging techniques and endoscopic ultrasound is necessary. Patients with high-risk stigmata (HRS, obstructive jaundice, enhanced solid component) should undergo resection. Patients with worrisome features (WF, cyst size ≥3 cm, thickened enhanced cyst walls, non-enhanced mural nodules, and clinical acute pancreatitis) may undergo either a strict surveillance based on patients' characteristics (age, comorbidities) or surgical resection. Non-operative management is indicated for BD-IPMNs without HRS and WF. Patients with BD-IPMN who do not undergo resection may develop malignant change over time as well as IPMN-distinct pancreatic cancer. However, non-operative management of BD-IPMNs lacking WF and HRS is safe and the risk of malignant degeneration seems relatively low. The optimal surveillance protocol is currently unclear.
authors: Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita e Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors: Stefano
authors: S
authors: Crippa
authors: Department of Surgery, Università Politecnica delle Marche, Ospedali Riuniti, Ancona, Italy.
authors: Alessandra
authors: A
authors: Piccioli
authors: Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita e Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors: Maria Chiara
authors: MC
authors: Salandini
authors: Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita e Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors: Chiara
authors: C
authors: Cova
authors: Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita e Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors: Francesca
authors: F
authors: Aleotti
authors: Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita e Salute University, Via Olgettina 60, 20132, Milan, Italy. falconi.massimo@hsr.it.
authors: Massimo
authors: M
authors: Falconi
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000175:diagnosis / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000601:surgery*; D019160:Endosonography; D006801:Humans; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome
keywords: Branch-duct; High-risk stigmata; Intraductal papillary mucinous neoplasms; Surgery; Surveillance; Worrisome features