[Strategy for surgical treatment of intraductal papillary-mucinous tumors]

The prognosis of malignant intraductal papillary mucinous tumors of the pancreas (IPMTs) should be considered more favorable than that of ordinary pancreatic ductal carcinoma. However, the preoperative diagnosis of malignancy is extremely difficult in IPMT. IPMT with a main pancreatic duct of less than 7 mm, or cystic lesion of less than 30 mm (branched type), or intramural nodule tumor of less than 4 mm, should be observed without performing surgery and followed carefully. The strategy for surgical treatment of IPMT is very important. Which procedure should be selected or performed? A radical operation should be performed with lymph node dissection if a preoperative diagnosis of malignancy is made. If cancer cannot be ruled out in an IPMT, a function-preserving procedure, such as pylorus-preserving pancreaticoduodenectomy, pancreatic head resection with second-portion duodenectomy, segmental resection, partial resection, or spleen-preserving distal pancreatectomy should be selected, and one of these procedures should be carried out with group I lymph node dissection. The greatest challenge in IPMT is making the diagnosis of benign or malignant and selecting the most appropriate treatment.