Alessandro Paniccia, Richard D Schulick, Barish H Edil, Martin D McCarter, Csaba Gajdos
Importance Intraductal Pancreatic Mucinous Neoplasms have been recognized with increasing frequency in clinical practice; however, several aspects of their clinical management are poorly defined. Few studies have ever focused on the intra- and post-operative management of the pancreatic remnant following curative intent surgical resection. Objective Overview of the current literature describing approaches to pancreatic preservation, local-regional and systemic recurrences following curative intent surgical interventions for intraductal pancreatic mucinous neoplasms. Findings Intraductal pancreatic mucinous neoplasms carry a variable risk of developing into noninvasive (high-grade dysplasia to carcinoma in situ) or invasive pancreatic cancer. Management of resection margin is dictated by the location of the lesion, by the grade of residual cellular dysplasia, and by patient’s overall health. In the majority of surgical series to date, the risk of recurrence of non-invasive intraductal pancreatic mucinous neoplasms seems to be lower when compared to invasive intraductal pancreatic mucinous neoplasms as the extent of the invasive component seems to predict outcome. The presence of adenoma or low-grade dysplasia at the transected pancreatic margin does not affect long-term survival. The role of adjuvant therapy in the setting of resected invasive intraductal pancreatic mucinous neoplasms is unclear, however, treatment regimens used to treat pancreatic adenocarcinoma seem reasonable. Pancreatic remnants should undergo surveillance with computed tomography scan or gadolinium enhanced magnetic resonance imaging following surgery. Conclusion Current knowledge of the management of pancreatic remnant in the setting of resected intraductal pancreatic mucinous neoplasms comes from retrospective series and is limited by small sample size and short follow-up. Additional studies with long term follow-up, focusing separately on main-duct intraductal pancreatic mucinous neoplasms and branchduct intraductal pancreatic mucinous neoplasm are needed to define the natural history of this disease and guide intraoperative and postoperative management.
