Strategies for multiple intraductal papillary-mucinous neoplasms of the pancreas

Abstract

Our strategy of surgical treatment of multiple IPMNs includes only borderline lesions (moderate dysplasia) or malignant ones, while the remaining tumors are observed closely without any surgical interventions as long as possible. Multiple non-invasive and benign tumors should be excised with combinations of some minimized surgical procedures. In such procedures, it is important to achieve complete resection of the tumor. A limited indication of total pancreatectomy remains for patients with apparently diffuse IPMNs because of the compromised postoperative insulin management and deterioration of quality of life. The utilization of intra-operative ultrasound with precise preoperative information about the tumor enhances a complete resection of tumor. Reconstruction of the pancreatic duct must be performed in pancreaticogastrostomy, which could allow the use of endoscopic investigations for recurrent or new IPMNs.