Table of Contents Author Guidelines Submit a Manuscript
Gastroenterology Research and Practice
Volume 2014 (2014), Article ID 269803, 10 pages
http://dx.doi.org/10.1155/2014/269803
Review Article

Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs

1Division of Pancreatic Surgery, Ospedali Riuniti, Università Politecnica delle Marche, Via Conca 71, 60126 Ancona, Italy
2Division of Pancreatic Surgery, Casa di Cura Dott. Pederzoli, Via Monte Baldo 24, Peschiera del Garda Verona 37019, Italy

Received 25 June 2014; Accepted 15 August 2014; Published 4 September 2014

Academic Editor: Niccola Funel

Copyright © 2014 Marina Paini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Appropriate surgical strategies for management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are a matter of debate. Preoperative and intraoperative evaluation of malignant potential of IPMN and of patient’s comorbidities is of paramount importance to balance potential complications of surgery with tumors’ risk of being or becoming malignant; the decision about the extent of pancreatic resection and the eventual total pancreatectomy needs to be determined on individual basis. The analysis of frozen-section margin of pancreas during operation is mandatory. The goal should be the complete resection of IPMN reaching negative margin, although there is still no agreed definition of “negative margin.” Of note, the presence of deepithelization is often wrongly interpreted as absence of neoplasia. Management of resection margin status and stratification of surveillance of the remnant pancreas, based on characteristics of primary tumour, are of crucial importance in the management of IPMNs in order to decrease the risk of tumor recurrence after resection. Although risk of local and distant recurrence for invasive IPMNs is increased even in case of total pancreatectomy, also local recurrence after complete resection of noninvasive IPMNs is not negligible. Therefore, a long-term/life-time follow-up monitoring is of paramount importance to detect eventual recurrences.