Fong Zhi Ven, Ferrone Cristina R, Lillemoe Keith D, Fernández-Del Castillo Carlos
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Ann Surg. 2016 May;263(5):908-17. doi: 10.1097/SLA.0000000000001567.
With the widespread use and advances in radiographic imaging, Intraductal Papillary Mucinous Neoplasms (IPMNs) of the pancreas are identified with increasing frequency. Although many studies have addressed its biology and treatment, true understanding of its natural history continues to elude us. Its malignant potential places careproviders in a clinical dilemma of balancing the morbidity of pancreatectomy against the risk of malignant transformation while under continuous surveillance. Recently, there have been conflicting data published in the literature, generating more uncertainty in the field. In this article, we critically analyze the contrasting consensus guidelines from the International Association of Pancreatology and the American Gastroenterology Association, and address lingering questions and controversies. We also synthesize newly published data in the context of current standard of care, and provide a comprehensive review and recommendations for the clinical diagnosis, treatment, and follow-up strategy in the management of patients with Intraductal Papillary Mucinous Neoplasms.
随着放射成像技术的广泛应用和发展，胰腺导管内乳头状黏液性肿瘤（IPMNs）的检出率日益增加。尽管许多研究已涉及该肿瘤的生物学特性及治疗方法，但我们仍未真正了解其自然病程。其恶性潜能使医护人员在持续监测过程中面临临床困境，即在胰腺切除手术的发病率与恶性转化风险之间进行权衡。最近，文献中公布的数据相互矛盾，给该领域带来了更多不确定性。在本文中，我们批判性地分析了国际胰腺病协会和美国胃肠病协会相互矛盾的共识指南，并探讨了悬而未决的问题和争议。我们还结合当前的治疗标准，综合新发表的数据，对导管内乳头状黏液性肿瘤患者的临床诊断、治疗及随访策略进行全面综述并提出建议。
