Farrell James J
Yale Pancreatic Disease Program, Interventional Endoscopy, Yale School of Medicine, New Haven, CT, USA.
Am J Gastroenterol. 2017 Jul;112(7):1162-1164. doi: 10.1038/ajg.2017.163.
The management of patients with pancreatic cysts, especially presumed branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), remains a challenge. BD-IPMNs carry a very low risk of malignancy and occur in predominantly older individuals who often die from causes not related to their pancreatic disease. The specific decision to stop surveillance of presumed low risk BD-IPMNs (those without either worrisome features (WF) or high risk stigmata (HRS)) is controversial, and needs to balance the real risk of malignancy or developing malignancy and IPMN-related mortality, with the patient's life expectancy, quality of life expectations, and mortality from non-pancreatic-related causes. With improved life expectancy, improved survival from non-pancreatic malignancies, rising health costs, and growing detection of ever smaller presumed BD-IPMNs, this issue is becoming ever more critical.
胰腺囊肿患者的管理，尤其是疑似分支导管内乳头状黏液性肿瘤（BD-IPMNs），仍然是一项挑战。BD-IPMNs的恶性风险极低，主要发生在老年个体中，这些个体往往死于与胰腺疾病无关的原因。对于疑似低风险BD-IPMNs（即没有令人担忧的特征（WF）或高风险体征（HRS）的患者）停止监测的具体决策存在争议，需要在恶性肿瘤或发生恶性肿瘤的实际风险以及IPMN相关死亡率与患者的预期寿命、生活质量期望以及非胰腺相关原因导致的死亡率之间取得平衡。随着预期寿命的提高、非胰腺恶性肿瘤生存率的提高、医疗成本的上升以及越来越小的疑似BD-IPMNs的检出率增加，这个问题变得越来越关键。
