The Challenges of Managing Patients with an IPMN

Several articles were recently published that highlight some of the many challenges in treating patients with an Intraductal papillary mucinous neoplasm (IPMN) of the pancreas. For example, Markus Büchler and colleagues from the University of Heidelberg published their experience treating 1439 patients with an IPMN ( ). The University of Heidelberg is one of Europe’s leading centers for the treatment of pancreatic tumors.
The team classified patients who underwent surgery into one of three groups- 1) Patients who, in retrospect, were operated on too early (they had low-grade IPMNs), 2) patients operated on in a “timely” manner (they had intermediate-grade or high-grade IPMNs), and 3) patients operated on “too late” (they had cancer). While we would like to think that most patients followed with an IPMN would fall into the operated on in a “timely” manner group, in fact, one-third fell into the too early group, one-third into the timely group, and one-third into the too late group. From this, the authors conclude that “At specialized referral centers, the risks of surgical morbidity and mortality are justifiable.” They also note that more work needs to be done to clarify the “biology and progression patterns” of IPMNs.
We fully agree with the latter statement. Our hope is that through the research ongoing in the Sol Goldman Center, we will develop new markers that can be used to definitively distinguish those patients who need surgery from those who can be safely followed clinically without surgery.

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