Lecture : Since their discovery, Intraductal Papillary Mucinous Neoplasms (IPMN) of the pancreas have been increasingly diagnosed. In the past, the majority of them were resected, considering their unknown evolutive potential, while today most IPMNs are enrolled in a surveillance program. However, whether we should follow or resect them is still debated. Among IPMNs, branch-duct IPMN hold the lower risk of malignant degeneration compared to main-duct IPMN, therefore for BD-IPMNs a conservative approach is generally considered. But, even BD-PMN are considered by some authors as a manifestation of a generalized process involving the entire pancreatic gland justifying a more aggressive approach, while the rate of development of malignancy reported by observational series demands to weigh the known risk associated with pancreatic surgery in favor of a non-operative management.
As pointed out by the recent literature, the observation of BD-IPMN throughout the years allow to define the behavior of the cyst, adding to the information that are drawn from a single observation. By defining the “movie” of the cyst, made of repeated observations, we can better select patients that actually require surgical resection. Furthermore, the identification of promising molecular biomarker will improve patients’ management, leading to the development of a tailored approach for BD-IPMN.
The combination of the recent evidence, collected by non-surgical series, and future biomarkers, will possibly mark the shift of BD-IPMN, from a disease that required almost invariably surgery, to one where only a small fraction of patients need to face the burden of a pancreatic resection.