Morales-Oyarvide Vicente, Fong Zhi Ven, Fernández-Del Castillo Carlos, Warshaw Andrew L
Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Visc Med. 2017 Dec;33(6):466-476. doi: 10.1159/000485014. Epub 2017 Dec 8.
Intraductal papillary mucinous neoplasms (IPMN) are cystic neoplasms with the potential for progression to pancreatic cancer. Recognized by the global medical community just over two decades ago, IPMN have gained great epidemiological and clinical relevance thanks to the widespread use of cross-sectional abdominal imaging, which has led to a surge in the number of incidental pancreatic cysts being diagnosed. As our understanding of this disease has improved, we now know that some IPMN have a very elevated risk of cancer and require surgical resection, while others are low-risk lesions and can be followed. The approach to IPMN must therefore strike a balance between preventing the over-utilization of surgery and the timely recognition and treatment of patients with high-risk lesions. Several clinical, radiographic, and laboratory parameters have been proposed to risk-stratify IPMN, leading to the publication of management guidelines that do not always converge in their recommendations. The goal of this clinical therapeutic review is to describe the strategic approach to IPMN at the Massachusetts General Hospital, and how our current understanding, management algorithm, and future directions have been informed by research efforts at our institution and other centers.
导管内乳头状黏液性肿瘤（IPMN）是一种具有发展为胰腺癌潜能的囊性肿瘤。IPMN在二十多年前才被全球医学界所认识，由于横断面腹部成像技术的广泛应用，其流行病学和临床相关性显著提高，这导致偶然诊断出的胰腺囊肿数量激增。随着我们对这种疾病认识的提高，现在我们知道，一些IPMN的癌症风险非常高，需要手术切除，而另一些则是低风险病变，可以进行随访观察。因此，IPMN的治疗方法必须在避免过度手术和及时识别及治疗高风险病变患者之间取得平衡。已经提出了几个临床、影像学和实验室参数来对IPMN进行风险分层，这导致了管理指南的发布，但其建议并不总是一致。本临床治疗综述的目的是描述麻省总医院对IPMN的治疗策略，以及我们目前的认识、管理算法和未来方向是如何受到我们机构和其他中心研究成果的影响的。
