Intraductal Papillary Mucinous Neoplasms (IPMN) of the Pancreas: an Update in Definition, Time to Progression, and Surgical Management

Aim of our update is to present the “state of art” about pancreatic intraductal papillary mucinous neoplasms (IPMN) and underline some significant notions that can be helpful in clinical practice. IPMN of the pancreas can be defined as neoplasms derived from pancreatic ductal system that produce mucin. The real incidence and prevalence of IPMN are not well defined. The radiological classification subdivides IPMN in three categories, in according to ductal involvement. One of the most confounding factors about pancreatic IPMN regards the high heterogeneity of these lesions, from which derives a different biological behavior and a different management. Although there are no clinical signs related to pancreatic IPMN, patient’s medical history and clinical examination are relevant. The differential diagnosis is relevant in order to detect potentially malignant lesions. Preoperative imaging should confirm the diagnosis of IPMN, indicate the risk of malignant cystic neoplasia, and define resectability. Data from literature showed that surgical treatment is indicated in case of main duct-IPMN, in concordance with the international consensus guidelines for management of IPMNs. Surgery is not mandatory in all patients with branch duct-IPMN, but only in 20% of cases or less; furthermore, in the absence of malignancy-related signs, careful non-operative management seems to be safe and effective in asymptomatic patients.