Is It Time to Expand the Role of Total Pancreatectomy for IPMN?

Abstract:

:Intraductal papillary mucinous neoplasms (IPMN) are cystic precursors to pancreatic cancer believed to arise within a widespread neoplastic field defect. The tendency for some patients to present with multifocal disease and/or develop additional lesions over time argues in favor of a field defect and complicates surgical management decisions. Surgery usually consists of partial pancreatic resection, which leaves behind a pancreatic remnant at risk for recurrent disease and progression to cancer. As an alternative, total pancreatectomy (TP) provides the most complete oncologic resection, but postoperative morbidity and quality of life (QoL) issues have generally limited its use to only the highest risk patients. Significant progress has been made in the management of the post-TP apancreatic state and studies now show less morbidity with acceptable QoL comparable to type 1 diabetic and post-pancreaticoduodenectomy patients. These improvements do not yet justify the routine use of TP, but they have opened the door for expansion to additional subsets of non-invasive IPMN. Here, we have identified several groups of patients that we believe would benefit from TP over partial resection based on the most current literature.

journal_name

Dig Surg

journal_title

Digestive surgery

authors

Griffin JF,Poruk KE,Wolfgang CL

doi

10.1159/000445019

subject

Has Abstract

pub_date

2016-01-01 00:00:00

pages

335-42

issue

4

eissn

0253-4886

issn

1421-9883

pii

000445019

journal_volume

33

pub_type

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