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Management of Cystic Neoplasms of the Pancreas Including IPMNs

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Pancreatic Cancer

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Abstract

The management of cystic pancreatic lesions fundamentally depends on knowing the cyst type and the risk or presence of malignancy. Only serous cystic neoplasms (SCN) are generally benign lesions, while mucinous cystic neoplasms (MCN) and intraductal papillary mucinous neoplasms (IPMN) as the most common cystic lesion and solid-pseudopapillary neoplasm (SPN) show different risk profiles for the development of invasive cancer. Once a cystic lesion is detected, the clinical decision is necessary if an upfront resection with the inherent morbidity of pancreatic surgery should be performed or if an observational management can be preferred. Whereas these strategies are clearly defined for certain cystic lesions including SCN, MCN, and SPN, the management of IPMN, especially with regard to the branch-duct type, remains partly controversial, and current guidelines differ with regard to indications for surgery and/or surveillance. The present chapter gives an overview on the different types of pancreatic cystic neoplasms and current diagnostic modalities. Furthermore, the indications for surgery, the variety of surgical resections, and the surveillance/follow-up strategies are discussed in the light of the current literature and guidelines.

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Abbreviations

AGA:

American Gastroenterological Association

BD:

Branch duct

CDX:

Caudal-related homeobox transcription factor

CT:

Computer tomography

ERCP:

Endoscopic retrograde cholangiopancreaticography

EUS:

Endoscopic ultrasound

FNA:

Fine needle aspiration

IAP:

International Association of Pancreatology

IPMN:

Intraductal papillary mucinous neoplasm

KRAS:

Kirsten rat sarcoma viral oncogene homolog

MCN:

Mucinous cystic neoplasm

MD:

Main duct

MRCP:

Magnetic resonance cholangiopancreaticography

MRI:

Magnetic resonance imaging

MUC:

Mucin protein

NECP:

Neuroendocrine cyst of the pancreas

PanIN:

Pancreatic intraepithelial neoplasm

PDAC:

Pancreatic ductal adenocarcinoma

SCN:

Serous cystic neoplasm

SPN:

Solid-pseudopapillary neoplasm

VHL:

von Hippel-Lindau

References

  1. Jani N, Bani Hani M, Schulick RD, et al. Diagnosis and management of cystic lesions of the pancreas. Diagn Ther Endosc. 2011;2011:478913.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bülow R, Simon P, Thiel R, Thamm P, Messner P, Lerch MM, Mayerle J, Völzke H, Hosten N, Kühn JP. Anatomic variants of the pancreatic duct and their clinical relevance: an MR-guided study in the general population. Eur Radiol. 2014;24(12):3142–9.

    Article  PubMed  Google Scholar 

  3. Kimura W, Nagai H, Kuroda A, Muto T, Esaki Y. Analysis of small cystic lesions of the pancreas. Int J Pancreatol. 1995;18(3):197–206.

    CAS  PubMed  Google Scholar 

  4. Gaujoux S, Brennan MF, Gonen M, D’Angelica MI, DeMatteo R, Fong Y, Schattner M, DiMaio C, Janakos M, Jarnagin WR, Allen PJ. Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212(4):590–600. discussion 600–3

    Article  PubMed  Google Scholar 

  5. Valsangkar NP, Morales-Oyarvide V, Thayer SP, Ferrone CR, Wargo JA, Warshaw AL, Fernández-del Castillo C. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery. 2012;152(3 Suppl 1):S4–12.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mayer P, Tjaden C, Klauß M. Diagnostic strategy and differential therapeutic approach for cystic lesions of the pancreas. Radiologe. 2016;56(4):338–47.

    Article  CAS  PubMed  Google Scholar 

  7. Basturk O, Hong SM, Wood LD, Adsay NV, Albores-Saavedra J, Biankin AV, Brosens LA, Fukushima N, Goggins M, Hruban RH, Kato Y, Klimstra DS, Klöppel G, Krasinskas A, Longnecker DS, Matthaei H, Offerhaus GJ, Shimizu M, Takaori K, Terris B, Yachida S, Esposito I, Furukawa T, Baltimore Consensus Meeting. A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol. 2015;39(12):1730–41.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Tanaka M, Chari S, Adsay V, International Association of Pancreatology, et al. International consensus guidelines for management of intraductal papillary mucinous neoplasms and mucinous cystic neoplasms of the pancreas. Pancreatology. 2006;6:17–32.

    Article  PubMed  Google Scholar 

  9. Tanaka M, Fernández-del Castillo C, Adsay V, International Association of Pancreatology, et al. International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology. 2012;12:183–97.

    Article  PubMed  Google Scholar 

  10. Fritz S, Klauss M, Bergmann F, et al. Small (Sendai negative) branch-duct IPMNs: not harmless. Ann Surg. 2012;256:313–20.

    Article  PubMed  Google Scholar 

  11. Salvia R, Fernández-del Castillo C, Bassi C, et al. Main-duct intraductal papillary mucinous neoplasms of the pancreas: clinical predictors of malignancy and long-term survival following resection. Ann Surg. 2004;239(5):678–85.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239(6):788–97.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Hackert T, Fritz S, Klauss M, et al. Main-duct intraductal papillary mucinous neoplasm: high cancer risk in duct diameter of 5 to 9 mm. Ann Surg. 2015;262(5):875–80. discussion 880–1

    Article  PubMed  Google Scholar 

  14. Sahora K, Mino-Kenudson M, Brugge W, et al. Branch duct intraductal papillary mucinous neoplasms: does cyst size change the tip of the scale? A critical analysis of the revised international consensus guidelines in a large single-institutional series. Ann Surg. 2013;258(3):466–75.

    Article  PubMed  Google Scholar 

  15. Maguchi H, Tanno S, Mizuno N, et al. Natural history of branch duct intraductal papillary mucinous neoplasms of the pancreas: a multicenter study in Japan. Pancreas. 2011;40(3):364–70.

    Article  PubMed  Google Scholar 

  16. Fritz S, Schirren M, Klauss M, et al. Clinicopathologic characteristics of patients with resected multifocal intraductal papillary mucinous neoplasm of the pancreas. Surgery. 2012;152:S74–80.

    Article  PubMed  Google Scholar 

  17. Marchegiani G, Mino-Kenudson M, Sahora K, et al. IPMN involving the main pancreatic duct: biology, epidemiology, and long-term outcomes following resection. Ann Surg. 2015;261(5):976–83.

    Article  PubMed  Google Scholar 

  18. Nakata K, Ohuchida K, Aishima S, et al. Invasive carcinoma derived from intestinal-type intraductal papillary mucinous neoplasm is associated with minimal invasion, colloid carcinoma, and less invasive behavior, leading to a better prognosis. Pancreas. 2011;40:581–7.

    Article  PubMed  Google Scholar 

  19. Furukawa T, Hatori T, Fujita I, et al. Prognostic relevance of morphological types of intraductal papillary mucinous neoplasms of the pancreas. Gut. 2011;60:509–16.

    Article  PubMed  Google Scholar 

  20. Rodriguez JR, Salvia R, Crippa S, et al. Branch-duct intraductal papillary mucinous neoplasms: observation in 145 patients who underwent resection. Gastroenterology. 2007;133:72–9. quiz 309–310

    Article  PubMed  PubMed Central  Google Scholar 

  21. Poultsides GA, Reddy S, Cameron JL, Hruban RH, Pawlik TM, Ahuja N, Jain A, Edil BH, Iacobuzio-Donahue CA, Schulick RD, Wolfgang CL. Histopathologic basis for the favorable survival after resection of intraductal papillary mucinous neoplasm-associated invasive adenocarcinoma of the pancreas. Ann Surg. 2010;251:470–6.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Goh BK, Tan YM, Chung YF, et al. A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg. 2006;30(12):2236–45.

    Article  PubMed  Google Scholar 

  23. Sakorafas GH, Smyrniotis V, Reid-Lombardo KM, et al. Primary pancreatic cystic neoplasms revisited: part II. Mucinous cystic neoplasms. Surg Oncol. 2011;20(2):e93–101.

    Article  PubMed  Google Scholar 

  24. Gil E, Choi SH, Choi DW, et al. Mucinous cystic neoplasms of the pancreas with ovarian stroma. ANZ J Surg. 2013;83:985–90.

    Article  PubMed  Google Scholar 

  25. Yamao K, Yanagisawa A, Takahashi K, et al. Clinicopathological features and prognosis of mucinous cystic neoplasm with ovarian-type stroma: a multi-institutional study of the Japan pancreas society. Pancreas. 2011;40(1):67–71.

    Article  CAS  PubMed  Google Scholar 

  26. Reid MD, Choi H, Balci S, et al. Serous cystic neoplasms of the pancreas: clinicopathologic and molecular characteristics. Semin Diagn Pathol. 2014;31(6):475–83.

    Article  PubMed  Google Scholar 

  27. Mohr VH, Vortmeyer AO, Zhuang Z, et al. Histopathology and molecular genetics of multiple cysts and microcystic (serous) adenomas of the pancreas in von Hippel-Lindau patients. Am J Pathol. 2000;157(5):1615–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Vortmeyer AO, Lubensky IA, Fogt F, et al. Allelic deletion and mutation of the von Hippel-Lindau (VHL) tumor suppressor gene in pancreatic microcystic adenomas. Am J Pathol. 1997;151(4):951–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Wu J, Matthaei H, Maitra A, et al. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med. 2011;106(8):1521–6.

    Google Scholar 

  30. Matsumoto T, Hirano S, Yada K, et al. Malignant serous cystic neoplasm of the pancreas: report of a case and review of the literature. J Clin Gastroenterol. 2005;39:253–6.

    Article  PubMed  Google Scholar 

  31. Del Chiaro M, Verbeke C, Salvia R, et al. European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis. 2013;45(9):703–11.

    Article  PubMed  Google Scholar 

  32. Reddy S, Cameron JL, Scudiere J, et al. Surgical management of solid pseudopapillary neoplasms of the pancreas (Franz or Hamoudi tumors): a large single-institutional series. J Am Coll Surg. 2009;208(5):950–7.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Law JK, Ahmed A, Singh VK, et al. A systematic review of solid-pseudopapillary neoplasms: are these rare lesions? Pancreas. 2014;43(3):331–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kubota Y, Kawakami H, Natsuizaka M, et al. CTNNB1 mutational analysis of solid-pseudopapillary neoplasms of the pancreas using endoscopic ultrasound-guided fine-needle aspiration and next-generation deep sequencing. J Gastroenterol. 2015;50(2):203–10.

    Article  CAS  PubMed  Google Scholar 

  35. Hruban RH, Adsay NV. Molecular classification of neoplasms of the pancreas. Hum Pathol. 2009;40:612–23.

    Article  CAS  PubMed  Google Scholar 

  36. Jones MJ, Buchanan AS, Neal CP, et al. Imaging of indeterminate pancreatic cystic lesions: a systematic review. Pancreatology. 2013;13:436–42.

    Article  CAS  PubMed  Google Scholar 

  37. Buerke B, Domagk D, Heindel W, et al. Diagnostic and radiological management of cystic pancreatic lesions: important features for radiologists. Clin Radiol. 2012;67:727–32.

    Article  CAS  PubMed  Google Scholar 

  38. D’Souza SL, Holub JL, Pavic BT, Rodriguez SA. A multicenter evaluation of the utilization of endoscopic ultrasound. Dig Endosc. 2016;28(7):738–43.

    Article  PubMed  Google Scholar 

  39. Das A, Ngamruengphong S, Nagendra S, Chak A. Asymptomatic pancreatic cystic neoplasm: a cost-effectiveness analysis of different strategies of management. Gastrointest Endosc. 2009;70(4):690–9.

    Article  PubMed  Google Scholar 

  40. Kadiyala V, Lee LS. Endosonography in the diagnosis and management of pancreatic cysts. World J Gastrointest Endosc. 2015;7(3):213–23.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Brugge WR, Lewandrowski K, Lee-Lewandrowski E, et al. Diagnosis of pancreatic cystic neoplasms: a report of the cooperative pancreatic cyst study. Gastroenterology. 2004;126:1330–6.

    Article  PubMed  Google Scholar 

  42. Rockacy M, Khalid A. Update on pancreatic cyst fluid analysis. Ann Gastroenterol. 2013;26(2):122–7.

    PubMed  PubMed Central  Google Scholar 

  43. Grenacher L, Strauß A, Bergmann F, Birdsey M, Mayerle J. Cyst. Features and risk of malignancy in intraductal papillary mucinous neoplasms of the pancreas: imaging and pathology. Viszeralmedizin. 2015;31(1):31–7.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Farrell JJ. Prevalence, diagnosis and management of pancreatic cystic neoplasms: current status and future directions. Gut Liver. 2015;9(5):571–89.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Shirley LA, Walker J, Krishna S, El-Dika S, Muscarella P, Ellison EC, Schmidt CR, Bloomston M. Routine cyst fluid cytology is not indicated in the evaluation of pancreatic cystic lesions. J Gastrointest Surg. 2016;20(9):1581–5.

    Article  PubMed  Google Scholar 

  46. Yip-Schneider MT, Wu H, Dumas RP, Hancock BA, Agaram N, Radovich M, Schmidt CM. Vascular endothelial growth factor, a novel and highly accurate pancreatic fluid biomarker for serous pancreatic cysts. J Am Coll Surg. 2014;218(4):608–17.

    Article  PubMed  Google Scholar 

  47. Wu J, Matthaei H, Maitra A, Dal Molin M, Wood LD, Eshleman JR, Goggins M, Canto MI, Schulick RD, Edil BH, Wolfgang CL, Klein AP, Diaz Jr LA, Allen PJ, Schmidt CM, Kinzler KW, Papadopoulos N, Hruban RH, Vogelstein B. Recurrent GNAS mutations define an unexpected pathway for pancreatic cyst development. Sci Transl Med. 2011;3(92):92ra66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Yoshioka T, Shigekawa M, Yamai T, Suda T, Kegasawa T, Iwahashi K, Ikezawa K, Sakamori R, Yakushijin T, Hiramatsu N, Tatsumi T, Takehara T. The safety and benefit of pancreatic juice cytology under ERCP in IPMN patients. Pancreatology. 2016. pii: S1424-3903(16)31177-2.

    Google Scholar 

  49. Esposito I, Schlitter AM, Sipos B, Klöppel G. Classification and malignant potential of pancreatic cystic tumors. Pathologe. 2015;36(1):99–112.

    Article  CAS  PubMed  Google Scholar 

  50. Salvia R, Malleo G, Marchegiani G, Pennacchio S, Paiella S, Paini M, Pea A, Butturini G, Pederzoli P, Bassi C. Pancreatic resections for cystic neoplasms: from the surgeon’s presumption to the pathologist’s reality. Surgery. 2012;152(3 Suppl 1):S135–42.

    Article  PubMed  Google Scholar 

  51. Crippa S, Bassi C, Salvia R, Malleo G, Marchegiani G, Rebours V, Levy P, Partelli S, Suleiman SL, Banks PA, Ahmed N, Chari ST, Fernández-Del Castillo C, Falconi M. Low progression of intraductal papillary mucinous neoplasms with worrisome features and high-risk stigmata undergoing non-operative management: a mid-term follow-up analysis. Gut. 2016. pii: gutjnl-2015-310162.

    Google Scholar 

  52. Barron MR, Roch AM, Waters JA, Parikh JA, DeWitt JM, Al-Haddad MA, Ceppa EP, House MG, Zyromski NJ, Nakeeb A, Pitt HA, Schmidt CM. Does preoperative cross-sectional imaging accurately predict main duct involvement in intraductal papillary mucinous neoplasm? J Gastrointest Surg. 2014;18(3):447–55. discussion 5455–6

    Article  CAS  PubMed  Google Scholar 

  53. Jang DK, Song BJ, Ryu JK, Chung KH, Lee BS, Park JK, Lee SH, Kim YT, Lee JY. Preoperative diagnosis of pancreatic cystic lesions: the accuracy of endoscopic ultrasound and cross-sectional imaging. Pancreas. 2015;44(8):1329–33.

    Article  PubMed  Google Scholar 

  54. Del Chiaro M, Segersvärd R, Pozzi Mucelli R, Rangelova E, Kartalis N, Ansorge C, Arnelo U, Blomberg J, Löhr M, Verbeke C. Comparison of preoperative conference-based diagnosis with histology of cystic tumors of the pancreas. Ann Surg Oncol. 2014;21(5):1539–44.

    Article  PubMed  Google Scholar 

  55. Vege SS, Ziring B, Jain R, et al. American gastroenterological association institute guideline on the diagnosis and management of asymptomatic neoplastic pancreatic cysts. Gastroenterology. 2015;148(4):819–22. quize 12–13

    Article  PubMed  Google Scholar 

  56. Postlewait LM, Ethun CG, McInnis MR, Merchant N, Parikh A, Idrees K, Isom CA, Hawkins W, Fields RC, Strand M, Weber SM, Cho CS, Salem A, Martin RC, Scoggins C, Bentrem D, Kim HJ, Carr J, Ahmad S, Abbott DE, Wilson GC, Kooby DA, Maithel SK. A multi-center study of 349 pancreatic mucinous cystic neoplasms: preoperative risk factors for malignancy. JAMA Surg. 2016;152(1):19–25.

    Article  Google Scholar 

  57. Hackert T, Michalski CW, Büchler MW. Invited commentary on “A multi-center study of 349 pancreatic mucinous cystic neoplasms: preoperative risk factors for malignancy” by Postlewait et al. JAMA Surg 2017;153(1):26.

    Google Scholar 

  58. Hackert T, Fritz S, Klauss M, Bergmann F, Hinz U, Strobel O, Schneider L, Büchler MW. Main-duct intraductal papillary mucinous neoplasm: high cancer risk in duct diameter of 5 to 9 mm. Ann Surg. 2015;262(5):8758–80. discussion 880–1

    Article  Google Scholar 

  59. Schmidt CM, White PB, Waters JA, Yiannoutsos CT, Cummings OW, Baker M, Howard TJ, Zyromski NJ, Nakeeb A, DeWitt JM, Akisik FM, Sherman S, Pitt HA, Lillemoe KD. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann Surg. 2007;246:644–51.

    Article  PubMed  Google Scholar 

  60. Jang JY, Kim SW, Lee SE, Yang SH, Lee KU, Lee YJ, Kim SC, Han DJ, Choi DW, Choi SH, Heo JS, Cho BH, Yu HC, Yoon DS, Lee WJ, Lee HE, Kang GH, Lee JM. Treatment guidelines for branch duct type intraductal papillary mucinous neoplasms of the pancreas: when can we operate or observe? Ann Surg Oncol. 2008;15:199–205.

    Article  PubMed  Google Scholar 

  61. Hackert T, Tjaden C, Büchler MW. Developments in pancreatic surgery during the past ten years. Zentralbl Chir. 2014;139:292–300.

    CAS  PubMed  Google Scholar 

  62. Tamura K, Ohtsuka T, Ideno N, Aso T, Shindo K, Aishima S, Ohuchida K, Takahata S, Ushijima Y, Ito T, Oda Y, Mizumoto K, Tanaka M. Treatment strategy for main duct intraductal papillary mucinous neoplasms of the pancreas based on the assessment of recurrence in the remnant pancreas after resection: a retrospective review. Ann Surg. 2014;259:360–8.

    Article  PubMed  Google Scholar 

  63. Hassenpflug M, Hinz U, Strobel O, Volpert J, Knebel P, Diener MK, Doerr-Harim C, Werner J, Hackert T, Büchler MW. Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial). Ann Surg. 2016;264(5):723–30.

    Article  PubMed  Google Scholar 

  64. Heeger K, Falconi M, Partelli S, Waldmann J, Crippa S, Fendrich V, Bartsch DK. Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbecks Arch Surg. 2014;399(3):315–21.

    Article  PubMed  Google Scholar 

  65. Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg. 2007;94:1254–9.

    Article  CAS  PubMed  Google Scholar 

  66. Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, Büchler MW, Werner J. Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbecks Arch Surg. 2011;396:1197–203.

    Article  PubMed  Google Scholar 

  67. Goudard Y, Gaujoux S, Dokmak S, Cros J, Couvelard A, Palazzo M, Ronot M, Vullierme MP, Ruszniewski P, Belghiti J, Sauvanet A. Reappraisal of central pancreatectomy a 12-year single-center experience. JAMA Surg. 2014;149:356–63.

    Article  PubMed  Google Scholar 

  68. Müller MW, Friess H, Kleeff J, Hinz U, Wente MN, Paramythiotis D, Berberat PO, Ceyhan GO, Büchler MW. Middle segmental pancreatic resection: an option to treat benign pancreatic body lesions. Ann Surg. 2006;244:909–18.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Zhang RC, Zhou YC, Mou YP, Huang CJ, Jin WW, Yan JF, et al. Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis. Surg Endosc. 2015;30(7):2657–65.

    Article  PubMed  Google Scholar 

  70. Song KB, Kim SC, Park KM, Hwang DW, Lee JH, Lee DJ, et al. Laparoscopic central pancreatectomy for benign or low-grade malignant lesions in the pancreatic neck and proximal body. Surg Endosc. 2015;29(4):937–46.

    Article  PubMed  Google Scholar 

  71. Schwarz L, Fleming J, Katz M, Lee J, Aloia T, Vauthey N, et al. Total laparoscopic central pancreatectomy with pancreaticogastrostomy for high-risk cystic neoplasm. Ann Surg Oncol. 2016;23(3):1035. doi:10.1245/s10434-015-4957-6.

    Article  CAS  PubMed  Google Scholar 

  72. Hol L, Bruno MJ, Cahen DL. Follow-up of asymptomatic pancreatic cysts in clinical practice: a vignette questionnaire. Pancreatology. 2016;16(3):416–22. doi:10.1016/j.pan.2016.02.007. Epub 23 Feb 2016.

    Google Scholar 

  73. He J, Cameron JL, Ahuja N, et al. Is it necessary to follow patients after resection of a benign pancreatic intraductal papillary mucinous neoplasm? J Am Coll Surg. 2013;216(4):657–65.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Marchegiani G, Mino-Kenudson M, Ferrone CR, Morales-Oyarvide V, Warshaw AL, Lillemoe KD, Castillo CF. Patterns of recurrence after resection of IPMN: who, when, and how? Ann Surg. 2015;262(6):1108–14.

    Article  PubMed  Google Scholar 

  75. Walsh RM, Vogt DP, Henderson JM, Hirose K, Mason T, Bencsath K, Hammel J, Brown N. Management of suspected pancreatic cystic neoplasms based on cyst size. Surgery. 2008;144(4):677–84. discussion 684–5

    Article  PubMed  Google Scholar 

  76. Wong J, Weber J, Centeno BA, Vignesh S, Harris CL, Klapman JB, Hodul P. High-grade dysplasia and adenocarcinoma are frequent in side-branch intraductal papillary mucinous neoplasm measuring less than 3 cm on endoscopic ultrasound. J Gastrointest Surg. 2013;17(1):78–84. discussion p. 84–5

    Article  PubMed  Google Scholar 

  77. Tjaden C, Michalski CW, Strobel O, Giese N, Hennche AK, Büchler MW, Hackert T. Clinical impact of structured follow-up after pancreatic surgery. Pancreas. 2016;45(6):895–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    C. Tjaden, Th. Hackert & M. W. Büchler

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  1. C. Tjaden
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  2. Th. Hackert
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  3. M. W. Büchler
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Correspondence to C. Tjaden .

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Editors and Affiliations

  1. Div. Surgery & Oncology, University of Liverpool, Liverpool, United Kingdom

    John P. Neoptolemos

  2. Rochester, Minnesota, USA

    Raul Urrutia

  3. Dept. Gastrointestinal Medical Onco, Duke University Medical Center Dept. Gastrointestinal Medical Onco, Durham, North Carolina, USA

    James Abbruzzese

  4. Heidelberg, Germany

    Markus W. Büchler

Section Editor information

  1. Duke University Medical Center, Durham, NC, USA

    James L. Abbruzzese

  2. Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Raul A. Urrutia

  3. Division of Surgery and Oncology, University of Liverpool, Daulby Street, Liverpool, UK

    John Neoptolemos

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler MD

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Tjaden, C., Hackert, T., Büchler, M.W. (2016). Management of Cystic Neoplasms of the Pancreas Including IPMNs. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6631-8_85-1

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