Management of Cystic Neoplasms of the Pancreas Including IPMNs

Abstract

The management of cystic pancreatic lesions fundamentally depends on knowing the cyst type and the risk or presence of malignancy. Only serous cystic neoplasms (SCN) are generally benign lesions, while mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) as the most common cystic lesion and solid-pseudopapillary neoplasm (SPN) show different risk profiles for the development of invasive cancer. Once a cystic lesion is detected, the clinical decision is necessary if an upfront resection with the inherent morbidity of pancreatic surgery should be performed or if an observational management can be preferred. Whereas these strategies are clearly defined for certain cystic lesions including SCN, MCN, and SPN, the management of IPMN, especially with regard to the branch-duct type, remains partly controversial, and current guidelines differ with regard to indications for surgery and/or surveillance. The present chapter gives an overview on the different types of pancreatic cystic neoplasms and current diagnostic modalities. Furthermore, the indications for surgery, the variety of surgical resections, and the surveillance/follow-up strategies are discussed in the light of the current literature and guidelines.