Department of General and Visceral Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Nat Rev Gastroenterol Hepatol. 2012 Mar 6;9(5):253-9. doi: 10.1038/nrgastro.2012.31.
Cystic pancreatic neoplasms are increasingly recognized, with intraductal papillary mucinous neoplasms of the pancreas (IPMNs) being the most frequently observed type. IPMNs are characterized by mucin production and epithelial growth within the pancreatic ducts, and are generally differentiated according to location: main pancreatic duct, its major side branches, or both (mixed type). IPMNs vary from benign to malignant and are considered precursor lesions of pancreatic adenocarcinoma. However, the exact time to neoplastic transformation and whether all IPMNs progress to malignant tumors is unclear. Surgical resection is warranted for all main-duct and mixed-type IPMNs (they harbor a high risk of malignancy of ~70%). By contrast, branch-duct IPMNs progress to cancer in only ~30% of cases. Thus, according to current guidelines (Sendai criteria), asymptomatic side-branch IPMNs <3 cm in size without suspicious radiological features (such as size progression) can be treated conservatively. Lately, even this approach has become controversial, owing to a number of Sendai-negative IPMNs showing malignant transformation. Although most IPMNs should be resected by standard oncological procedures (including lymphadenectomy), small Sendai-negative IPMNs can be treated with limited resections. This Review summarizes current knowledge of the treatment of IPMNs, with a particular focus on surgical approaches to this disease.
胰腺囊性肿瘤的发病率逐渐增高，其中最常见的类型是胰腺导管内乳头状黏液性肿瘤（IPMNs）。IPMNs 的特征是在胰腺导管内产生黏液和上皮细胞增生，通常根据位置进行区分：主胰管、其主要分支或两者（混合型）。IPMNs 从良性到恶性不等，被认为是胰腺腺癌的癌前病变。然而，确切的癌变时间以及是否所有 IPMNs 都会进展为恶性肿瘤尚不清楚。所有主胰管和混合型 IPMNs（恶性风险约为 70%）都需要手术切除。相比之下，分支胰管型 IPMNs 仅有约 30%的病例进展为癌症。因此，根据目前的指南（仙台标准），无症状的分支胰管型 IPMN 大小＜3cm 且无可疑影像学特征（如大小进展）可以保守治疗。最近，即使是这种方法也存在争议，因为许多仙台阴性的 IPMNs 显示出恶性转化。虽然大多数 IPMNs 应通过标准的肿瘤学手术（包括淋巴结清扫术）切除，但较小的仙台阴性 IPMNs 可以采用有限的切除术进行治疗。本综述总结了 IPMNs 的治疗现状，特别关注了针对该疾病的手术方法。
