Abstract
Surveillance of IPMN is quite controversial. IPMN is a slow-growing tumor and non-neoplastic lesions (hyperplasia) sometimes show clinical manifestations similar to those of adenoma or adenocarcinoma. IPMN frequently develops in the elderly. When surgical treatment is indicated, such an invasive procedure as pancreaticoduodenectomy or total pancreatectomy is often required. Furthermore, an increase in the prevalence of comorbid diseases and a decrease in tolerability for surgery with aging are also problematic. In branch duct IPMN, patients having cysts with smooth walls and containing thin septum-like structures do not have to undergo frequent follow-up examinations. Those with papillary protrusions less than 5 mm in height can be followed up, while in cases with protrusions greater than that, surgery is recommended. Association of dilation of the main pancreatic duct is regarded as an indicator of malignancy. Recently, several papers have reported synchronous or heterochronous development of common-type duct cell adenocarcinoma of the pancreas in patients with IPMN. Therefore, it is necessary to assess the entire pancreas at the time of follow-up. In addition, the prevalence of malignancies of other organs is also high in IPMN patients. These issues should be taken into account when planning a surveillance program for IPMN patients.
