Is surgery required for patients with intraductal papillary mucinous neoplasms without mural nodules?

In this Practice Point commentary, we discuss the findings and implications of a study by Tanno et al. that prospectively followed 82 consecutive patients with branch-duct intraductal papillary mucinous neoplasms (IPMNs) without mural nodules. Patients were followed using CT and/or magnetic resonance cholangiopancreatography, and the median follow-up period was 61 months. Remarkably, 84.1% of the lesions did not change significantly over the period of observation. Only 11% of the IPMNs grew >1 cm, and only 4.9% developed a mural nodule. Patients who showed significant progression underwent surgery; none of the patients managed in this way developed an invasive carcinoma. The authors suggest that branch-duct IPMNs without mural nodules can be followed using regular imaging and should be resected only if they cause symptoms, if they become >30 mm, if they are associated with dilatation of the main pancreatic duct, or if they contain a mural nodule.