[Surgery for lesions at risk for pancreatic cancer]

Preventive surgery of pancreatic adenocarcinoma is warranted by the substantial benefit in prognosis observed in some diseases at high-risk for malignant transformation. The main indication is intraductal papillary and mucinous neoplasms, in which surgical resection must be proposed in case of main duct involvement. Conversely, in branch-duct IPMN, surgical indications are selective and based mainly on imaging findings. Mucinous cystadenoma is almost exclusively observed in female, and often localized in the distal pancreas and amenable to a limited resection. Chronic alcoholic pancreatitis results in a moderately increased risk of pancreatic cancer but screening by imaging is difficult. Concerning familial chronic pancreatitis, risk of cancer is very important and warrants resection up to total pancreatectomy. Familial pancreatic cancer and some others genetic predispositions are less known. The first step of their management is an oncogenetician counsel. If screening is indicated, it should rely mainly on MRI and endoscopic ultrasound. However, indications of preventive pancreatectomy are difficult to established, both concerning time and extent of resection.