Do all intraductal papillary mucinous neoplasms (IPMNs) require surgery?

The reality is that not all intraductal papillary mucinous neoplasms, or IPNMs, are the same, and they don’t all harbor the same risk. When you talk about risk, pancreatic cancer surgery is safer than it has ever been, but it’s still a tough operation. It’s still an operation that if you don’t need it, you don’t want it. But if you need it, you want to have it done early and selectively.

We now categorize IPNMs. If the neoplasms are coming off the side branches of the pancreatic duct instead of the main duct -- think of it like a tree trunk; you have your normal tree trunk and you have these little branches coming off of it -- and if it’s just isolated to the side branches, then your chance of getting pancreatic cancer is very low, probably less than 1 percent per year for the rest of your lifetime.

We put those people into what we call an active surveillance program. I like to say active surveillance rather than observation because people say, “Doc, aren’t you going to operate on me? You’re going to observe me, you’re going to do nothing?” No, we’re going to actively follow you. And we’ll get an MRI on those people once a year, maybe sometimes once every other year.

If the cancer, or the neoplasm, involves the main duct, the main trunk of the tree, then we know those people have a much higher risk for malignancy. If we can isolate the cancer in one part of the pancreas, the left side or the right side, those are the people we’re going to operate on.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.