Abstract
We report the strategy for treatment of main duct intraductal papillary-mucinous neoplasms (IPMN) of the pancreas based on our experience of 70 patients with IPMN and international consensus guidelines. The proportion of malignant IPMN in the main duct IPMN was significantly (p < 0.01) higher than in the branch duct IPMN. A positive preoperative cytological examination of pancreatic juice and the presence of jaundice were useful markers for the diagnosis of malignant and invasive IPMN, respectively. However, imaging examination could not definitely distinguish benign from malignant IPMN or non-invasive from invasive IPMN. All main duct IPMNs should be resected because of high frequency of malignancy in the main duct IPMN and the difficulty of preoperative differentiation between benign and malignant IPMN. Pancreatectomy with lymph node dissection, rather than pancreatectomy alone, is recommended for main duct IPMN because it is difficult to differentiate between non-invasive and invasive IPMN preoperatively and the frequency of extrapancreatic invasion, including lymph node metastasis, is high in invasive IPMN. Frozen section of the surgical pancreatic margin is mandatory in the intraoperative management of main duct IPMN. If invasive carcinoma, carcinoma in situ and PanIN 3 are detected at the surgical margin, further resection is recommended.
