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Updated: Aug 6, 2026
Robotic Duodenum-preserving Total Pancreatic Head Resection for Intraductal Papillary Mucinous Neoplasms
Published on: April 17, 2026
DIAGNOSIS AND MANAGEMENT OF INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS: A NARRATIVE REVIEW BASED ON INTERNATIONAL
Claudia Teresa Carvente1, Henrique Carvente Toledo2, Carlos Fischer de Toledo1
1Universidade Federal de São Paulo - Escola Paulista de Medicina, Departamento de Medicina, Disciplina de Gastroenterologia, São Paulo, SP, Brasil.
Background:
Intraductal papillary mucinous neoplasms (IPMNs) are the leading cause of incidentally detected pancreatic cysts and exhibit a wide biological spectrum with variable malignant potential. Recent advances in imaging, endoscopic assessment, molecular testing, and artificial intelligence have improved risk stratification and influenced contemporary international guidelines.
Objective:
To synthesize the most recent evidence on the diagnosis, risk stratification, and management of IPMNs, with emphasis on comparing the Fukuoka (2017), European (2018), and Kyoto (2024) guidelines, and on the integration of emerging technologies.
Methods:
A structured narrative review was conducted based on major international clinical guidelines and systematic reviews identified through PubMed/MEDLINE and Embase. Eligible publications in English from 2020 to 2025 addressing clinical, radiologic, molecular, and management-related aspects of IPMNs were included.
Results:
Diagnosis primarily relies on magnetic resonance imaging and endoscopic ultrasound, supplemented by fine-needle aspiration, molecular analysis of cyst fluid, and emerging tools such as radiomics and artificial intelligence models. International guidelines differ in risk criteria, anatomic thresholds, and recommended surveillance intervals, directly influencing decisions between follow-up and surgical resection. Minimally invasive techniques, including EUS-guided radiofrequency ablation and intralesional chemoablation, are under investigation as alternative options for patients who are not surgical candidates.
Conclusion:
The management of IPMNs should be individualized and multidimensional, integrating clinical, radiologic, and molecular information within the framework of updated guidelines. Active surveillance is safe for low-risk lesions, whereas surgery remains indicated for patients with high-risk stigmata. Emerging technologies including radiomics, artificial intelligence, and next-generation sequencing, are expected to enhance diagnostic precision and support personalized therapeutic decision-making.
