Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2015; 21(34): 9833-9837
Published online Sep 14, 2015. doi: 10.3748/wjg.v21.i34.9833
International guidelines for the management of pancreatic intraductal papillary mucinous neoplasms
Brian KP Goh
Brian KP Goh, Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore 169856, Singapore
Brian KP Goh, Duke -National University of Singapore Graduate Medical School, Singapore 169857, Singapore
Author contributions: Goh BKP contributed to this paper.
Conflict-of-interest statement: There are no conflicts of interest in relation to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Brian KP Goh, MBBS, MMed, MSc, FRCS(Ed), FAMS, Associate Professor, Senior Consultant, Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital, Academia, 20 College Road, Singapore 169856, Singapore. bsgkp@hotmail.com
Telephone: +65-63265564 Fax: +65-62209323
Received: January 28, 2015
Peer-review started: January 29, 2015
First decision: March 26, 2015
Revised: April 10, 2015
Accepted: June 10, 2015
Article in press: June 10, 2015
Published online: September 14, 2015

The management of intraductal papillary mucinous neoplasms (IPMN) is presently evolving as a result of the improved understanding of the natural history and biological behavior of the different pancreatic cystic neoplasms; and better preoperative diagnosis of these neoplasms due to advancement in preoperative diagnostic tools. International consensus guidelines for the management of IPMN were first formulated in 2006 and subsequently revised in 2012. Both these guidelines were constructed based on expert opinion and not on robust clinical data. The main limitation of the original Sendai guidelines was that it had a low positive predictive value resulting in many benign neoplasms being resected. Hence, these guidelines were revised in 2012. However, although the updated guidelines resulted in an improvement in the positive predictive value over the Sendai Guidelines, the results of several studies validating these guidelines demonstrated that its positive predictive value remained low. Furthermore, although both guidelines were associated with high negative predictive values, several investigators have demonstrated that some malignant IPMNs may be missed. Finally, it is imperative to emphasize that major considerations when managing a patient with IPMN including the patient’s surgical risk, life-expectancy and even cost of investigations are not taken into account in current guidelines. The management of a patient with IPMN should be individualized and tailored according to a patient’s risk benefit profile for resection vs surveillance.

Keywords: Intraductal papillary mucinous neoplasms, Pancreatic cystic neoplasms, Cystic lesions of the pancreas, Mucinous cystic neoplasms, Pancreatic cysts, Guidelines, Management

Core tip: Current guidelines of the management of intraductal papillary mucinous neoplasms are limited by the low positive predictive value resulting in many benign neoplasms being resected. Furthermore, despite a high negative predictive value, some malignant neoplasms may be missed based on these guidelines.