Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1092-1100
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1092
Observation or resection of pancreatic intraductal papillary mucinous neoplasm: An ongoing tug of war
Jan Rune Aunan, Nigel B. Jamieson, Kjetil Søreide
Jan Rune Aunan, Kjetil Søreide, Department of Gastrointestinal Surgery, HPB Unit, Stavanger University Hospital, Stavanger 4068, Norway
Nigel B. Jamieson, Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow G61 1BD, United Kingdom
Nigel B. Jamieson, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, United Kingdom
Kjetil Søreide, Gastrointestinal Translational Research Unit, Laboratory for Molecular Medicine, Stavanger University Hospital, Stavanger 4068, Norway
Kjetil Søreide, Department of Clinical Medicine, University of Bergen, Bergen 5003, Norway
Author contributions: Aunan JR and Søreide K planned the search and outline of the paper; Aunan JR, Jamieson NB and Søreide K performed the literature search; Aunan JR drafted the first version; Aunan JR, Jamieson NB and Søreide K performed several rounds of revisions; Aunan JR, Jamieson NB and Søreide K accepted the final version for submission.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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/
Corresponding author: Kjetil Søreide, FRCS (Ed), MD, PhD, Professor, Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, Stavanger 4068, Norway. ksoreide@mac.com
Telephone: +47-51-518000 Fax: +47-51-519919
Received: May 21, 2019
Peer-review started: May 23, 2019
First decision: August 23, 2019
Revised: September 3, 2019
Accepted: September 26, 2019
Article in press: September 26, 2019
Published online: December 15, 2019
Processing time: 203 Days and 7.6 Hours
Abstract

An increasing number of patients are being referred to pancreatic centres around the world due to often incidentally discovered cystic neoplasms of the pancreas. The evaluation and management of pancreatic cystic neoplasms is a controversial topic and with existing guidelines based on a lack of strong evidence there is discordance between centres and guidelines with regard to when to offer surgery and when to favour surveillance. The frequency, duration and modality of surveillance is also controversial as this is resource-consuming and must be balanced against the perceived benefits and risks involved. While there is consensus that the risk of malignancy should be balanced against the life-expectancy and comorbidities, the indications for surgery and surveillance strategies vary among the guidelines. Thus, the tug of war between surveillance or resection continues. Here we discuss the recommendations from guidelines with further accumulating data and emerging reports on intraductal papillary mucinous neoplasm in the literature.

Keywords: Neoplasia; Pancreatic cancer; Pancreatic cyst; Diagnosis; Resection; Surveillance; Mutation; Biomarker

Core tip: For patients with intraductal papillary mucinous neoplasia detected in the pancreas, there is currently debate over the frequency, duration and modality of surveillance in the long-term. Surveillance is resource-consuming and must be balanced against the likely benefits and perceived risks for malignant transformation. Furthermore, the risk of malignancy should be balanced against the overall life-expectancy and comorbidities. Notably, the indications for either surgery or surveillance vary among the available guidelines. Thus, the tug of war between surveillance or resection continues. The recommendations from existing guidelines are highlighted with further accumulating data and emerging reports from the intraductal papillary mucinous neoplasm literature.