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

James F. Griffin, Katherine E. Poruk, Christopher L. Wolfgang

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)335-342
Number of pages8
JournalDigestive Surgery
Volume33
Issue number4
DOIs
StatePublished - May 1 2016

Keywords

  • Field defect
  • IPMD
  • IPMN recurrence
  • Intraductal papillary mucinous neoplasm
  • Multifocal IPMN
  • PDAC
  • Pancreatic cancer
  • Total pancreatectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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