European evidence-based guidelines on pancreatic cystic neoplasms

European Study Group on Cystic Tumours of the Pancreas, Marco Del Chiaro, Marc G Besselink, Lianne Scholten, Marco J Bruno, Djuna L Cahen, Thomas M Gress, Jeanin E van Hooft, Markus M Lerch, Julia Mayerle, Thilo Hackert, Sohei Satoi, Alessandro Zerbi, David Cunningham, Claudio De Angelis, Marc Giovannini, Enrique De-Madaria, Peter Hegyi, Jonas Rosendahl, Helmut Friess, Riccardo Manfredi, Philippe Lévy, Francisco X Real, Alain Sauvanet, Mohammed Abu Hilal, Giovanni Marchegiani, Irene Esposito, Paula Ghaneh, Marc Rw Engelbrecht, Paul Fockens, Nadine Cm van Huijgevoort, Christopher Wolfgang, Claudio Bassi, Natalya B Gubergrits, Caroline Verbeke, Günter Klöppel, Aldo Scarpa, Giuseppe Zamboni, Anne Marie Lennon, Malin Sund, Nikolaos Kartalis, Lars Grenacher, Massimo Falconi, Urban Arnelo, Kostantin V Kopchak, Kofi Oppong, Colin Mckay, Truls Hauge, Kevin Conlon, Mustapha Adham, Güralp O Ceyhan, Roberto Salvia, Christos Dervenis, Peter Allen, François Paye, Detlef K Bartsch, Matthias Löhr, Massimiliano Mutignani, Johanna Laukkarinen, Richard Schulick, Roberto Valente, Thomas Seufferlein, Gabriele Capurso, Ajith Siriwardena, John P Neoptolemos, Aldis Pukitis, Ralf Segersvärd, A Aghdassi, S Andrianello, P Bossuyt, R Bülow, K Cárdenas-Jaén, P Cortegoso, M Fontana, L Haeberle, M Heckler, A Litvin, K Mann, C Michalski, P Michl, G Nappo, G Perri, S Persson, F Scheufele, F Sclafani, M Schmidt, L Venezia, F Volker, M-P Vullierm, L Wüsten, European Study Group on Cystic Tumours of the Pancreas, Marco Del Chiaro, Marc G Besselink, Lianne Scholten, Marco J Bruno, Djuna L Cahen, Thomas M Gress, Jeanin E van Hooft, Markus M Lerch, Julia Mayerle, Thilo Hackert, Sohei Satoi, Alessandro Zerbi, David Cunningham, Claudio De Angelis, Marc Giovannini, Enrique De-Madaria, Peter Hegyi, Jonas Rosendahl, Helmut Friess, Riccardo Manfredi, Philippe Lévy, Francisco X Real, Alain Sauvanet, Mohammed Abu Hilal, Giovanni Marchegiani, Irene Esposito, Paula Ghaneh, Marc Rw Engelbrecht, Paul Fockens, Nadine Cm van Huijgevoort, Christopher Wolfgang, Claudio Bassi, Natalya B Gubergrits, Caroline Verbeke, Günter Klöppel, Aldo Scarpa, Giuseppe Zamboni, Anne Marie Lennon, Malin Sund, Nikolaos Kartalis, Lars Grenacher, Massimo Falconi, Urban Arnelo, Kostantin V Kopchak, Kofi Oppong, Colin Mckay, Truls Hauge, Kevin Conlon, Mustapha Adham, Güralp O Ceyhan, Roberto Salvia, Christos Dervenis, Peter Allen, François Paye, Detlef K Bartsch, Matthias Löhr, Massimiliano Mutignani, Johanna Laukkarinen, Richard Schulick, Roberto Valente, Thomas Seufferlein, Gabriele Capurso, Ajith Siriwardena, John P Neoptolemos, Aldis Pukitis, Ralf Segersvärd, A Aghdassi, S Andrianello, P Bossuyt, R Bülow, K Cárdenas-Jaén, P Cortegoso, M Fontana, L Haeberle, M Heckler, A Litvin, K Mann, C Michalski, P Michl, G Nappo, G Perri, S Persson, F Scheufele, F Sclafani, M Schmidt, L Venezia, F Volker, M-P Vullierm, L Wüsten

Abstract

Evidence-based guidelines on the management of pancreatic cystic neoplasms (PCN) are lacking. This guideline is a joint initiative of the European Study Group on Cystic Tumours of the Pancreas, United European Gastroenterology, European Pancreatic Club, European-African Hepato-Pancreato-Biliary Association, European Digestive Surgery, and the European Society of Gastrointestinal Endoscopy. It replaces the 2013 European consensus statement guidelines on PCN. European and non-European experts performed systematic reviews and used GRADE methodology to answer relevant clinical questions on nine topics (biomarkers, radiology, endoscopy, intraductal papillary mucinous neoplasm (IPMN), mucinous cystic neoplasm (MCN), serous cystic neoplasm, rare cysts, (neo)adjuvant treatment, and pathology). Recommendations include conservative management, relative and absolute indications for surgery. A conservative approach is recommended for asymptomatic MCN and IPMN measuring <40 mm without an enhancing nodule. Relative indications for surgery in IPMN include a main pancreatic duct (MPD) diameter between 5 and 9.9 mm or a cyst diameter ≥40 mm. Absolute indications for surgery in IPMN, due to the high-risk of malignant transformation, include jaundice, an enhancing mural nodule >5 mm, and MPD diameter >10 mm. Lifelong follow-up of IPMN is recommended in patients who are fit for surgery. The European evidence-based guidelines on PCN aim to improve the diagnosis and management of PCN.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Indications for surgery. EUS, endoscopic ultrasound; IPMN, intraductal papillary mucinous neoplasm.

References

    1. Ip IK, Mortele KJ, Prevedello LM, et al. . Focal cystic pancreatic lesions: assessing variation in radiologists' management recommendations. Radiology 2011;259:136–41. 10.1148/radiol.10100970
    1. Girometti R, Intini S, Brondani G, et al. . Incidental pancreatic cysts on 3D turbo spin echo magnetic resonance cholangiopancreatography: prevalence and relation with clinical and imaging features. Abdom Imaging 2011;36:196–205. 10.1007/s00261-010-9618-4
    1. Chang YR, Park JK, Jang JY, et al. . Incidental pancreatic cystic neoplasms in an asymptomatic healthy population of 21,745 individuals: large-scale, single-center cohort study. Medicine (Baltimore) 2016;95:e5535 10.1097/MD.0000000000005535
    1. de Jong K, Nio CY, Hermans JJ, et al. . High prevalence of pancreatic cysts detected by screening magnetic resonance imaging examinations. Clin Gastroenterol Hepatol 2010;8:806–11. 10.1016/j.cgh.2010.05.017
    1. Del Chiaro M, Segersvärd R, Lohr M, et al. . Early detection and prevention of pancreatic cancer: is it really possible today? World J Gastroenterol 2014;20:12118–31. 10.3748/wjg.v20.i34.12118
    1. Del Chiaro M, Segersvärd R, Pozzi Mucelli R, et al. . Comparison of preoperative conference-based diagnosis with histology of cystic tumors of the pancreas. Ann Surg Oncol 2014;21:1539–44. 10.1245/s10434-013-3465-9
    1. Del Chiaro M, Verbeke C, Salvia R, et al. . European experts consensus statement on cystic tumours of the pancreas. Dig Liver Dis 2013;45:703–11. 10.1016/j.dld.2013.01.010
    1. Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al. . Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. Pancreatology 2017;17:738–53. 10.1016/j.pan.2017.07.007
    1. 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;148:819–22. quize12-3 10.1053/j.gastro.2015.01.015
    1. Jaeschke R, Guyatt GH, Dellinger P, et al. . Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive. BMJ 2008;337:a744 10.1136/bmj.a744
    1. Atkins D, Best D, Briss PA, et al. . Grading quality of evidence and strength of recommendations. BMJ 2004;328:1490 10.1136/bmj.328.7454.1490
    1. Guyatt GH, Oxman AD, Vist GE, et al. . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6. 10.1136/
    1. Hruban RH, Kloeppel G, Bofetta P, et al. . Tumours of the pancreas : Bosman FT, Carneiro F, Hruban RH, WHO classification of tumours of the digestive system. 4th ed Lyon: International Agency for Research on Cancer, 2010:280–330.
    1. Jang JY, Park T, Lee S, et al. . Proposed nomogram predicting the individual risk of malignancy in the patients with branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2017;266:1062–8. 10.1097/SLA.0000000000001985
    1. Wang W, Zhang L, Chen L, et al. . Serum carcinoembryonic antigen and carbohydrate antigen 19-9 for prediction of malignancy and invasiveness in intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Biomed Rep 2015;3:43–50. 10.3892/br.2014.376
    1. Kim JR, Jang JY, Kang MJ, et al. . Clinical implication of serum carcinoembryonic antigen and carbohydrate antigen 19-9 for the prediction of malignancy in intraductal papillary mucinous neoplasm of pancreas. J Hepatobiliary Pancreat Sci 2015;22:699–707. 10.1002/jhbp.275
    1. Singhi AD, Nikiforova MN, Fasanella KE, et al. . Preoperative GNAS and KRAS testing in the diagnosis of pancreatic mucinous cysts. Clin Cancer Res 2014;20:4381–9. 10.1158/1078-0432.CCR-14-0513
    1. Springer S, Wang Y, Dal Molin M, et al. . A combination of molecular markers and clinical features improve the classification of pancreatic cysts. Gastroenterology 2015;149:1501–10. 10.1053/j.gastro.2015.07.041
    1. Singhi AD, Zeh HJ, Brand RE, et al. . American Gastroenterological Association guidelines are inaccurate in detecting pancreatic cysts with advanced neoplasia: a clinicopathologic study of 225 patients with supporting molecular data. Gastrointest Endosc 2016;83:1107–17. 10.1016/j.gie.2015.12.009
    1. Kadayifci A, Atar M, Wang JL, et al. . Value of adding GNAS testing to pancreatic cyst fluid KRAS and carcinoembryonic antigen analysis for the diagnosis of intraductal papillary mucinous neoplasms. Dig Endosc 2017;29:111–7. 10.1111/den.12710
    1. Al-Rashdan A, Schmidt CM, Al-Haddad M, et al. . Fluid analysis prior to surgical resection of suspected mucinous pancreatic cysts. A single centre experience. J Gastrointest Oncol 2011;2:208–14. 10.3978/j.issn.2078-6891.2011.020
    1. van der Waaij LA, van Dullemen HM, Porte RJ. Cyst fluid analysis in the differential diagnosis of pancreatic cystic lesions: a pooled analysis. Gastrointest Endosc 2005;62:383–9. 10.1016/S0016-5107(05)01581-6
    1. Jang DK, Song BJ, Ryu JK, et al. . Preoperative diagnosis of pancreatic cystic lesions: the accuracy of endoscopic ultrasound and cross-sectional imaging. Pancreas 2015;44:1329–33. 10.1097/MPA.0000000000000396
    1. Lee HJ, Kim MJ, Choi JY, et al. . Relative accuracy of CT and MRI in the differentiation of benign from malignant pancreatic cystic lesions. Clin Radiol 2011;66:315–21. 10.1016/j.crad.2010.06.019
    1. Sainani NI, Saokar A, Deshpande V, et al. . Comparative performance of MDCT and MRI with MR cholangiopancreatography in characterizing small pancreatic cysts. AJR Am J Roentgenol 2009;193:722–31. 10.2214/AJR.08.1253
    1. Visser BC, Muthusamy VR, Yeh BM, et al. . Diagnostic evaluation of cystic pancreatic lesions. HPB (Oxford) 2008;10:63–9. 10.1080/13651820701883155
    1. Song SJ, Lee JM, Kim YJ, et al. . Differentiation of intraductal papillary mucinous neoplasms from other pancreatic cystic masses: comparison of multirow-detector CT and MR imaging using ROC analysis. J Magn Reson Imaging 2007;26:86–93. 10.1002/jmri.21001
    1. Laffan TA, Horton KM, Klein AP, et al. . Prevalence of unsuspected pancreatic cysts on MDCT. AJR Am J Roentgenol 2008;191:802–7. 10.2214/AJR.07.3340
    1. Spinelli KS, Fromwiller TE, Daniel RA, et al. . Cystic pancreatic neoplasms: observe or operate. Ann Surg 2004;239:651–7.
    1. Lee KS, Sekhar A, Rofsky NM, et al. . Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 2010;105:2079–84. 10.1038/ajg.2010.122
    1. Zhang X-M, Mitchell DG, Dohke M, Holland GA, et al. . Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 2002;223:547–53. 10.1148/radiol.2232010815
    1. Kromrey ML, Bülow R, Hübner J, et al. . Prospective study on the incidence, prevalence and 5-year pancreatic-related mortality of pancreatic cysts in a population-based study. Gut 2018;67:138–45. 10.1136/gutjnl-2016-313127
    1. Sahani DV, Kambadakone A, Macari M, et al. . Diagnosis and management of cystic pancreatic lesions. AJR Am J Roentgenol 2013;200:343–54. 10.2214/AJR.12.8862
    1. Chaudhari VV, Raman SS, Vuong NL, et al. . Pancreatic cystic lesions: discrimination accuracy based on clinical data and high resolution CT features. J Comput Assist Tomogr 2007;31:860–7. 10.1097/RCT.0b013e318039b277
    1. de Jong K, Nio CY, Mearadji B, et al. . Disappointing interobserver agreement among radiologists for a classifying diagnosis of pancreatic cysts using magnetic resonance imaging. Pancreas 2012;41:278–82. 10.1097/MPA.0b013e31822899b6
    1. Waters JA, Schmidt CM, Pinchot JW, et al. . CT vs MRCP: optimal classification of IPMN type and extent. J Gastrointest Surg 2008;12:101–9. 10.1007/s11605-007-0367-9
    1. Pilleul F, Rochette A, Partensky C, et al. . Preoperative evaluation of intraductal papillary mucinous tumors performed by pancreatic magnetic resonance imaging and correlated with surgical and histopathologic findings. J Magn Reson Imaging 2005;21:237–44. 10.1002/jmri.20254
    1. Berland LL, Silverman SG, Gore RM, et al. . Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010;7:754–73. 10.1016/j.jacr.2010.06.013
    1. Sodickson A, Baeyens PF, Andriole KP, et al. . Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 2009;251:175–84. 10.1148/radiol.2511081296
    1. Curry CA, Eng J, Horton KM, et al. . CT of primary cystic pancreatic neoplasms: can CT be used for patient triage and treatment? AJR Am J Roentgenol 2000;175:99–103. 10.2214/ajr.175.1.1750099
    1. Demos TC, Posniak HV, Harmath C, et al. . Cystic lesions of the pancreas. AJR Am J Roentgenol 2002;179:1375–88. 10.2214/ajr.179.6.1791375
    1. Pozzi-Mucelli RM, Rinta-Kiikka I, Wünsche K, et al. . Pancreatic MRI for the surveillance of cystic neoplasms: comparison of a short with a comprehensive imaging protocol. Eur Radiol 2017;27:41–50. 10.1007/s00330-016-4377-4
    1. Kartalis N, Lindholm TL, Aspelin P, et al. . Diffusion-weighted magnetic resonance imaging of pancreas tumours. Eur Radiol 2009;19:1981–90. 10.1007/s00330-009-1384-8
    1. Hwang J, Kim YK, Min JH, Jeong WK, et al. . Comparison between MRI with MR cholangiopancreatography and endoscopic ultrasonography for differentiating malignant from benign mucinous neoplasms of the pancreas. Eur Radiol 2018;28:179–87. 10.1007/s00330-017-4926-5
    1. Donahue TR, Hines OJ, Farrell JJ, et al. . Cystic neoplasms of the pancreas: results of 114 cases. Pancreas 2010;39:1271–6. 10.1097/MPA.0b013e3181e1d6f4
    1. Kim JH, Eun HW, Park HJ, et al. . Diagnostic performance of MRI and EUS in the differentiation of benign from malignant pancreatic cyst and cyst communication with the main duct. Eur J Radiol 2012;81:2927–35. 10.1016/j.ejrad.2011.12.019
    1. Gress F, Gottlieb K, Cummings O, et al. . Endoscopic ultrasound characteristics of mucinous cystic neoplasms of the pancreas. Am J Gastroenterol 2000;95:961–5. 10.1111/j.1572-0241.2000.01976.x
    1. Yamao K, Nakamura T, Suzuki T, et al. . Endoscopic diagnosis and staging of mucinous cystic neoplasms and intraductal papillary-mucinous tumors. J Hepatobiliary Pancreat Surg 2003;10:142–6. 10.1007/s00534-002-0802-y
    1. Ahmad NA, Kochman ML, Lewis JD, et al. . Can EUS alone differentiate between malignant and benign cystic lesions of the pancreas? Am J Gastroenterol 2001;96:3295–300. 10.1111/j.1572-0241.2001.05328.x
    1. Ahmad NA, Kochman ML, Brensinger C, et al. . Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions. Gastrointest Endosc 2003;58:59–64. 10.1067/mge.2003.298
    1. Kamata K, Kitano M, Omoto S, et al. . Contrast-enhanced harmonic endoscopic ultrasonography for differential diagnosis of pancreatic cysts. Endoscopy 2016;48:35–41. 10.1055/s-0034-1393564
    1. Harima H, Kaino S, Shinoda S, et al. . Differential diagnosis of benign and malignant branch duct intraductal papillary mucinous neoplasm using contrast-enhanced endoscopic ultrasonography. World J Gastroenterol 2015;21:6252–60. 10.3748/wjg.v21.i20.6252
    1. Fusaroli P, Kypraios D, Mancino MG, et al. . Interobserver agreement in contrast harmonic endoscopic ultrasound. J Gastroenterol Hepatol 2012;27:1063–9. 10.1111/j.1440-1746.2012.07115.x
    1. de Jong K, van Hooft JE, Nio CY, et al. . Accuracy of preoperative workup in a prospective series of surgically resected cystic pancreatic lesions. Scand J Gastroenterol 2012;47:1056–63. 10.3109/00365521.2012.674970
    1. Ardengh JC, Lopes CV, de Lima-Filho ER, et al. . Impact of endoscopic ultrasound-guided fine-needle aspiration on incidental pancreatic cysts. A prospective study. Scand J Gastroenterol 2014;49:114–20. 10.3109/00365521.2013.854830
    1. Gillis A, Cipollone I, Cousins G, et al. . Does EUS-FNA molecular analysis carry additional value when compared to cytology in the diagnosis of pancreatic cystic neoplasm? A systematic review. HPB (Oxford) 2015;17:377–86. 10.1111/hpb.12364
    1. Al-Haddad M, DeWitt J, Sherman S, et al. . Performance characteristics of molecular (DNA) analysis for the diagnosis of mucinous pancreatic cysts. Gastrointest Endosc 2014;79:79–87. 10.1016/j.gie.2013.05.026
    1. 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. 10.1053/j.gastro.2004.02.013
    1. Cizginer S, Turner BG, Turner B, Bilge AR, et al. . Cyst fluid carcinoembryonic antigen is an accurate diagnostic marker of pancreatic mucinous cysts. Pancreas 2011;40:1024–8. 10.1097/MPA.0b013e31821bd62f
    1. Gaddam S, Ge PS, Keach JW, et al. . Suboptimal accuracy of carcinoembryonic antigen in differentiation of mucinous and nonmucinous pancreatic cysts: results of a large multicenter study. Gastrointest Endosc 2015;82:1060–9. 10.1016/j.gie.2015.04.040
    1. Jin DX SA, Vollmer CM, Jhala N, et al. . A lower cyst fluid CEA cut-off increases diagnostic accuracy in identifying mucinous pancreatic cystic lesions. J Pancreas 2015;16:271–7.
    1. Kadayifci A, Al-Haddad M, Atar M, et al. . The value of KRAS mutation testing with CEA for the diagnosis of pancreatic mucinous cysts. Endosc Int Open 2016;4:E391–6. 10.1055/s-0042-101755
    1. Khalid A, Zahid M, Finkelstein SD, et al. . Pancreatic cyst fluid DNA analysis in evaluating pancreatic cysts: a report of the PANDA study. Gastrointest Endosc 2009;69:1095–102. 10.1016/j.gie.2008.07.033
    1. Winner M, Sethi A, Poneros JM, et al. . The role of molecular analysis in the diagnosis and surveillance of pancreatic cystic neoplasms. JOP 2015;16:143–9.
    1. Ngamruengphong S, Bartel MJ, Raimondo M. Cyst carcinoembryonic antigen in differentiating pancreatic cysts: a meta-analysis. Dig Liver Dis 2013;45:920–6. 10.1016/j.dld.2013.05.002
    1. Sedlack R, Affi A, Vazquez-Sequeiros E, et al. . Utility of EUS in the evaluation of cystic pancreatic lesions. Gastrointest Endosc 2002;56:543–7. 10.1016/S0016-5107(02)70440-9
    1. Koito K, Namieno T, Nagakawa T, et al. . Solitary cystic tumor of the pancreas: EUS-pathologic correlation. Gastrointest Endosc 1997;45:268–76. 10.1016/S0016-5107(97)70269-4
    1. Morris-Stiff G, Lentz G, Chalikonda S, et al. . Pancreatic cyst aspiration analysis for cystic neoplasms: mucin or carcinoembryonic antigen--which is better? Surgery 2010;148:638–45. discussion 44-5 10.1016/j.surg.2010.07.023
    1. Tarantino I, Fabbri C, Di Mitri R, et al. . Complications of endoscopic ultrasound fine needle aspiration on pancreatic cystic lesions: final results from a large prospective multicenter study. Dig Liver Dis 2014;46:41–4. 10.1016/j.dld.2013.08.134
    1. Barresi L, Tarantino I, Traina M, et al. . Endoscopic ultrasound-guided fine needle aspiration and biopsy using a 22-gauge needle with side fenestration in pancreatic cystic lesions. Dig Liver Dis 2014;46:45–50. 10.1016/j.dld.2013.06.008
    1. Al-Haddad M, Wallace MB, Woodward TA, et al. . The safety of fine-needle aspiration guided by endoscopic ultrasound: a prospective study. Endoscopy 2008;40:204–8. 10.1055/s-2007-995336
    1. Lee LS, Saltzman JR, Bounds BC, et al. . EUS-guided fine needle aspiration of pancreatic cysts: a retrospective analysis of complications and their predictors. Clin Gastroenterol Hepatol 2005;3:231–6. 10.1016/S1542-3565(04)00618-4
    1. Varadarajulu S, Eloubeidi MA. Frequency and significance of acute intracystic hemorrhage during EUS-FNA of cystic lesions of the pancreas. Gastrointest Endosc 2004;60:631–5. 10.1016/S0016-5107(04)01891-7
    1. O’Toole D, Palazzo L, Arotçarena R, et al. . Assessment of complications of EUS-guided fine-needle aspiration. Gastrointest Endosc 2001;53:470–4. 10.1067/mge.2001.112839
    1. Bournet B, Migueres I, Delacroix M, et al. . Early morbidity of endoscopic ultrasound: 13 years' experience at a referral center. Endoscopy 2006;38:349–54. 10.1055/s-2005-921173
    1. Guarner-Argente C, Shah P, Buchner A, et al. . Use of antimicrobials for EUS-guided FNA of pancreatic cysts: a retrospective, comparative analysis. Gastrointest Endosc 2011;74:81–6. 10.1016/j.gie.2011.03.1244
    1. Suzuki R, Thosani N, Annangi S, et al. . Diagnostic yield of EUS-FNA-based cytology distinguishing malignant and benign IPMNs: a systematic review and meta-analysis. Pancreatology 2014;14:380–4. 10.1016/j.pan.2014.07.006
    1. Siech M, Tripp K, Schmidt-Rohlfing B, et al. . Cystic tumours of the pancreas: diagnostic accuracy, pathologic observations and surgical consequences. Langenbecks Arch Surg 1998;383:56–61. 10.1007/s004230050092
    1. Hara T, Yamaguchi T, Ishihara T, et al. . Diagnosis and patient management of intraductal papillary-mucinous tumor of the pancreas by using peroral pancreatoscopy and intraductal ultrasonography. Gastroenterology 2002;122:34–43. 10.1053/gast.2002.30337
    1. Navez J, Hubert C, Gigot JF, et al. . Impact of intraoperative pancreatoscopy with intraductal biopsies on surgical management of intraductal papillary mucinous neoplasm of the pancreas. J Am Coll Surg 2015;221:982–7. 10.1016/j.jamcollsurg.2015.07.451
    1. Konda VJ, Meining A, Jamil LH, et al. . A pilot study of in vivo identification of pancreatic cystic neoplasms with needle-based confocal laser endomicroscopy under endosonographic guidance. Endoscopy 2013;45:1006–13. 10.1055/s-0033-1344714
    1. Nakai Y, Iwashita T, Park DH, et al. . Diagnosis of pancreatic cysts: EUS-guided, through-the-needle confocal laser-induced endomicroscopy and cystoscopy trial: DETECT study. Gastrointest Endosc 2015;81:1204–14. 10.1016/j.gie.2014.10.025
    1. Le Pen C, Palazzo L, Napoléon B. A health economic evaluation of needle-based confocal laser endomicroscopy for the diagnosis of pancreatic cysts. Endosc Int Open 2017;5:E987–95. 10.1055/s-0043-117947
    1. Napoléon B, Lemaistre AI, Pujol B, et al. . A novel approach to the diagnosis of pancreatic serous cystadenoma: needle-based confocal laser endomicroscopy. Endoscopy 2015;47:26–32. 10.1055/s-0034-1390693
    1. 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;258:466–75. 10.1097/SLA.0b013e3182a18f48
    1. Fritz S, Klauss M, Bergmann F, et al. . Pancreatic main-duct involvement in branch-duct IPMNs: an underestimated risk. Ann Surg 2014;260:848–55. discussion 55-6 10.1097/SLA.0000000000000980
    1. Aso T, Ohtsuka T, Matsunaga T, et al. . "High-risk stigmata" of the 2012 international consensus guidelines correlate with the malignant grade of branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreas 2014;43:1239–43. 10.1097/MPA.0000000000000199
    1. Nguyen AH, Toste PA, Farrell JJ, et al. . Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer. J Gastrointest Surg 2015;19:258–65. 10.1007/s11605-014-2693-z
    1. Roch AM, Ceppa EP, DeWitt JM, et al. . International consensus guidelines parameters for the prediction of malignancy in intraductal papillary mucinous neoplasm are not properly weighted and are not cumulative. HPB (Oxford) 2014;16:929–35. 10.1111/hpb.12305
    1. Goh BK, Thng CH, Tan DM, et al. . Evaluation of the Sendai and 2012 International Consensus Guidelines based on cross-sectional imaging findings performed for the initial triage of mucinous cystic lesions of the pancreas: a single institution experience with 114 surgically treated patients. Am J Surg 2014;208:202–9. 10.1016/j.amjsurg.2013.09.031
    1. Dortch JD, Stauffer JA, Asbun HJ. Pancreatic resection for side-branch intraductal papillary mucinous neoplasm (SB-IPMN): a contemporary single-institution experience. J Gastrointest Surg 2015;19:1603–9. 10.1007/s11605-015-2851-y
    1. Robles EP, Maire F, Cros J, et al. . Accuracy of 2012 International Consensus Guidelines for the prediction of malignancy of branch-duct intraductal papillary mucinous neoplasms of the pancreas. United European Gastroenterol J 2016;4:580–6. 10.1177/2050640615623370
    1. Seo N, Byun JH, Kim JH, et al. . Validation of the 2012 International Consensus Guidelines using computed tomography and magnetic resonance imaging: branch duct and main duct intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2016;263:557–64. 10.1097/SLA.0000000000001217
    1. 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;262:875–80. discussion 80-1 10.1097/SLA.0000000000001462
    1. Abdeljawad K, Vemulapalli KC, Schmidt CM, et al. . Prevalence of malignancy in patients with pure main duct intraductal papillary mucinous neoplasms. Gastrointest Endosc 2014;79:623–9. 10.1016/j.gie.2013.08.024
    1. Hirono S, Tani M, Kawai M, et al. . The carcinoembryonic antigen level in pancreatic juice and mural nodule size are predictors of malignancy for branch duct type intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2012;255:517–22. 10.1097/SLA.0b013e3182444231
    1. Kawada N, Uehara H, Nagata S, et al. . Mural nodule of 10 mm or larger as predictor of malignancy for intraductal papillary mucinous neoplasm of the pancreas: pathological and radiological evaluations. Pancreatology 2016;16:441–8. 10.1016/j.pan.2015.12.008
    1. Kobayashi N, Sugimori K, Shimamura T, et al. . Endoscopic ultrasonographic findings predict the risk of carcinoma in branch duct intraductal papillary mucinous neoplasms of the pancreas. Pancreatology 2012;12:141–5. 10.1016/j.pan.2011.12.008
    1. Shimizu Y, Yamaue H, Maguchi H, et al. . Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers. Pancreas 2013;42:883–8. 10.1097/MPA.0b013e31827a7b84
    1. Crippa S, Bassi C, Salvia R, et al. . 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 2017;66:495–506. 10.1136/gutjnl-2015-310162
    1. Kang MJ, Jang JY, Kim SJ, et al. . Cyst growth rate predicts malignancy in patients with branch duct intraductal papillary mucinous neoplasms. Clin Gastroenterol Hepatol 2011;9:87–93. 10.1016/j.cgh.2010.09.008
    1. Kwong WT, Lawson RD, Hunt G, et al. . Rapid growth rates of suspected pancreatic cyst branch duct intraductal papillary mucinous neoplasms predict malignancy. Dig Dis Sci 2015;60:2800–6. 10.1007/s10620-015-3679-8
    1. Han Y, Lee H, Kang JS, et al. . Progression of pancreatic branch duct intraductal papillary mucinous neoplasm associates with cyst size. Gastroenterology 2018;154:576–84. 10.1053/j.gastro.2017.10.013
    1. Lafemina J, Katabi N, Klimstra D, et al. . Malignant progression in IPMN: a cohort analysis of patients initially selected for resection or observation. Ann Surg Oncol 2013;20:440–7. 10.1245/s10434-012-2702-y
    1. Roch AM, Ceppa EP, Al-Haddad MA, et al. . The natural history of main duct-involved, mixed-type intraductal papillary mucinous neoplasm: parameters predictive of progression. Ann Surg 2014;260:680–8. 10.1097/SLA.0000000000000927
    1. Roch AM, DeWitt JM, Al-Haddad MA, et al. . Nonoperative management of main pancreatic duct-involved intraductal papillary mucinous neoplasm might be indicated in select patients. J Am Coll Surg 2014;219:122–9. 10.1016/j.jamcollsurg.2014.03.021
    1. Del Chiaro M, Ateeb Z, Hansson MR, et al. . Survival analysis and risk for progression of intraductal papillary mucinous neoplasia of the pancreas (IPMN) under surveillance: a single-institution experience. Ann Surg Oncol 2017;24:1120–6. 10.1245/s10434-016-5661-x
    1. Masica DL, Dal Molin M, Wolfgang CL, et al. . A novel approach for selecting combination clinical markers of pathology applied to a large retrospective cohort of surgically resected pancreatic cysts. J Am Med Inform Assoc 2017;24:145–52. 10.1093/jamia/ocw069
    1. Woo SM, Ryu JK, Lee SH, et al. . Branch duct intraductal papillary mucinous neoplasms in a retrospective series of 190 patients. Br J Surg 2009;96:405–11. 10.1002/bjs.6557
    1. Sadakari Y, Ienaga J, Kobayashi K, et al. . Cyst size indicates malignant transformation in branch duct intraductal papillary mucinous neoplasm of the pancreas without mural nodules. Pancreas 2010;39:232–6. 10.1097/MPA.0b013e3181bab60e
    1. Jang JY, Park T, Lee S, et al. . Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms. Br J Surg 2014;101:686–92. 10.1002/bjs.9491
    1. Ohtsuka T, Kono H, Nagayoshi Y, et al. . An increase in the number of predictive factors augments the likelihood of malignancy in branch duct intraductal papillary mucinous neoplasm of the pancreas. Surgery 2012;151:76–83. 10.1016/j.surg.2011.07.009
    1. Crippa S, Pezzilli R, Bissolati M, et al. . Active surveillance beyond 5 years is required for presumed branch-duct intraductal papillary mucinous neoplasms undergoing non-operative management. Am J Gastroenterol 2017;112:1153–61. 10.1038/ajg.2017.43
    1. Lawrence SA, Attiyeh MA, Seier K, et al. . Should patients with cystic lesions of the pancreas undergo long-term radiographic surveillance? Results of 3024 patients evaluated at a single institution. Ann Surg 2017;266:536–44. 10.1097/SLA.0000000000002371
    1. Sahora K, Ferrone CR, Brugge WR, et al. . Effects of comorbidities on outcomes of patients with intraductal papillary mucinous neoplasms. Clin Gastroenterol Hepatol 2015;13:1816–23. 10.1016/j.cgh.2015.04.177
    1. Pugliese L, Keskin M, Maisonneuve P, et al. . Increased incidence of extrapancreatic neoplasms in patients with IPMN: fact or fiction? A critical systematic review. Pancreatology 2015;15:209–16. 10.1016/j.pan.2015.03.007
    1. Larghi A, Panic N, Capurso G, et al. . Prevalence and risk factors of extrapancreatic malignancies in a large cohort of patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Oncol 2013;24:1907–11. 10.1093/annonc/mdt184
    1. Marchegiani G, Malleo G, D’Haese JG, et al. . Association between pancreatic intraductal papillary mucinous neoplasms and extrapancreatic malignancies. Clin Gastroenterol Hepatol 2015;13:1162–9. 10.1016/j.cgh.2014.11.029
    1. Mimura T, Masuda A, Matsumoto I, et al. . Predictors of malignant intraductal papillary mucinous neoplasm of the pancreas. J Clin Gastroenterol 2010;44:e224–e229. 10.1097/MCG.0b013e3181d8fb91
    1. Tian X, Gao H, Ma Y, et al. . Surgical treatment and prognosis of 96 cases of intraductal papillary mucinous neoplasms of the pancreas: a retrospective cohort study. Int J Surg 2015;13:49–53. 10.1016/j.ijsu.2014.11.028
    1. Sahora K, Fernández-del Castillo C, Dong F, et al. . Not all mixed-type intraductal papillary mucinous neoplasms behave like main-duct lesions: implications of minimal involvement of the main pancreatic duct. Surgery 2014;156:611–21. 10.1016/j.surg.2014.04.023
    1. Scholten L, van Huijgevoort NC, Bruno M, et al. . Surgical management of main duct IPMN and mixed type IPMN: an international survey and case-vignette study among experts. Pancreatology 2017;17:S87 10.1016/j.pan.2017.05.276
    1. Ito T, Doi R, Yoshizawa A, et al. . The distribution of atypical epithelium in main-duct type intraductal papillary mucinous neoplasms of the pancreas. J Hepatobiliary Pancreat Sci 2011;18:241–9. discussion 6-9 10.1007/s00534-010-0337-6
    1. Watanabe Y, Nishihara K, Niina Y, et al. . Validity of the management strategy for intraductal papillary mucinous neoplasm advocated by the international consensus guidelines 2012: a retrospective review. Surg Today 2016;46:1045–52. 10.1007/s00595-015-1292-2
    1. 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;216:657–65. discussion 65-7 10.1016/j.jamcollsurg.2012.12.026
    1. Tamura K, Ohtsuka T, Ideno N, et al. . 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. 10.1097/SLA.0b013e3182a690ff
    1. Ogawa H, Itoh S, Ikeda M, et al. . Intraductal papillary mucinous neoplasm of the pancreas: assessment of the likelihood of invasiveness with multisection CT. Radiology 2008;248:876–86. 10.1148/radiol.2482071578
    1. Shin SH, Han DJ, Park KT, et al. . Validating a simple scoring system to predict malignancy and invasiveness of intraductal papillary mucinous neoplasms of the pancreas. World J Surg 2010;34:776–83. 10.1007/s00268-010-0416-5
    1. Jun DY, Kwon HJ, Kim SG, et al. . Predictive factors for invasive intraductal papillary mucinous neoplasm of the pancreas. Korean J Hepatobiliary Pancreat Surg 2011;15:237–42. 10.14701/kjhbps.2011.15.4.237
    1. Kawakubo K, Tada M, Isayama H, et al. . Disease-specific mortality among patients with intraductal papillary mucinous neoplasm of the pancreas. Clin Gastroenterol Hepatol 2014;12:486–91. 10.1016/j.cgh.2013.06.032
    1. Kang MJ, Jang JY, Lee S, et al. . Clinicopathological meaning of size of main-duct dilatation in intraductal papillary mucinous neoplasm of pancreas: proposal of a simplified morphological classification based on the investigation on the size of main pancreatic duct. World J Surg 2015;39:2006–13. 10.1007/s00268-015-3062-0
    1. Fritz S, Hackert T, Hinz U, et al. . Role of serum carbohydrate antigen 19-9 and carcinoembryonic antigen in distinguishing between benign and invasive intraductal papillary mucinous neoplasm of the pancreas. Br J Surg 2011;98:104–10. 10.1002/bjs.7280
    1. Wong J, Weber J, Centeno BA, et al. . 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;17:78–85. discussion p-5 10.1007/s11605-012-2017-0
    1. Jang JY, Kim SW, Lee SE, et al. . 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. 10.1245/s10434-007-9603-5
    1. Fritz S, Klauss M, Bergmann F, et al. . Small (Sendai negative) branch-duct IPMNs. Ann Surg 2012;256:313–20. 10.1097/SLA.0b013e31825d355f
    1. Goh BK. International guidelines for the management of pancreatic intraductal papillary mucinous neoplasms. World J Gastroenterol 2015;21:9833–7. 10.3748/wjg.v21.i34.9833
    1. Sugiyama M, Izumisato Y, Abe N, et al. . Predictive factors for malignancy in intraductal papillary-mucinous tumours of the pancreas. Br J Surg 2003;90:1244–9. 10.1002/bjs.4265
    1. Del Chiaro M, Verbeke CS, Kartalis N, et al. . Short-term results of a magnetic resonance imaging-based Swedish screening program for individuals at risk for pancreatic cancer. JAMA Surg 2015;150:512–8. 10.1001/jamasurg.2014.3852
    1. Faitot F, Gaujoux S, Barbier L, et al. . Reappraisal of pancreatic enucleations: a single-center experience of 126 procedures. Surgery 2015;158:201–10. 10.1016/j.surg.2015.03.023
    1. Goudard Y, Gaujoux S, Dokmak S, et al. . Reappraisal of central pancreatectomy a 12-year single-center experience. JAMA Surg 2014;149:356–63. 10.1001/jamasurg.2013.4146
    1. Partelli S, Fernandez-Del Castillo C, Bassi C, et al. . Invasive intraductal papillary mucinous carcinomas of the pancreas: predictors of survival and the role of lymph node ratio. Ann Surg 2010;251:477–82. 10.1097/SLA.0b013e3181cf9155
    1. Tol JA, Gouma DJ, Bassi C, et al. . Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2014;156:591–600. 10.1016/j.surg.2014.06.016
    1. Ohtsuka T, Kono H, Tanabe R, et al. . Follow-up study after resection of intraductal papillary mucinous neoplasm of the pancreas; special references to the multifocal lesions and development of ductal carcinoma in the remnant pancreas. Am J Surg 2012;204:44–8. 10.1016/j.amjsurg.2011.04.007
    1. Salvia R, Partelli S, Crippa S, et al. . Intraductal papillary mucinous neoplasms of the pancreas with multifocal involvement of branch ducts. Am J Surg 2009;198:709–14. 10.1016/j.amjsurg.2008.10.022
    1. 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–S80. 10.1016/j.surg.2012.05.025
    1. Rosenblatt R, Dorfman V, Epelboym I, et al. . Demographic features and natural history of intermediate-risk multifocal versus unifocal intraductal papillary mucinous neoplasms. Pancreas 2015;44:478–83. 10.1097/MPA.0000000000000264
    1. Matthaei H, Norris AL, Tsiatis AC, et al. . Clinicopathological characteristics and molecular analyses of multifocal intraductal papillary mucinous neoplasms of the pancreas. Ann Surg 2012;255:326–33. 10.1097/SLA.0b013e3182378a18
    1. Kwon JH, Kim SC, Song KB, et al. . Surgical outcomes of multifocal branch duct intraductal papillary mucinous neoplasms of pancreas. Korean J Hepatobiliary Pancreat Surg 2014;18:152–8. 10.14701/kjhbps.2014.18.4.152
    1. Yamaguchi J, Kaneoka Y, Maeda A, et al. . Positive surgical margins in surgically treated unifocal and multifocal IPMN. Int J Surg 2016;28:51–5. 10.1016/j.ijsu.2016.02.065
    1. Fujii T, Kato K, Kodera Y, et al. . Prognostic impact of pancreatic margin status in the intraductal papillary mucinous neoplasms of the pancreas. Surgery 2010;148:285–90. 10.1016/j.surg.2010.03.013
    1. Marchegiani G, Mino-Kenudson M, Ferrone CR, et al. . Patterns of recurrence after resection of IPMN. Ann Surg 2015;262:1108–14. 10.1097/SLA.0000000000001008
    1. Pea A, Yu J, Rezaee N, et al. . Targeted DNA sequencing reveals patterns of local progression in the pancreatic remnant following resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Surg 2017;266:133-141 10.1097/SLA.0000000000001817
    1. White R, D’Angelica M, Katabi N, et al. . Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm. J Am Coll Surg 2007;204:987–93. discussion 93-5 10.1016/j.jamcollsurg.2006.12.040
    1. Park J, Lee KT, Jang TH, et al. . Risk factors associated with the postoperative recurrence of intraductal papillary mucinous neoplasms of the pancreas. Pancreas 2011;40:46–51. 10.1097/MPA.0b013e3181f66b74
    1. Nara S, Shimada K, Sakamoto Y, et al. . Clinical significance of frozen section analysis during resection of intraductal papillary mucinous neoplasm: should a positive pancreatic margin for adenoma or borderline lesion be resected additionally? J Am Coll Surg 2009;209:614–21. 10.1016/j.jamcollsurg.2009.07.023
    1. Landa J, Allen P, D’Angelica M, et al. . Recurrence patterns of intraductal papillary mucinous neoplasms of the pancreas on enhanced computed tomography. J Comput Assist Tomogr 2009;33:838–43. 10.1097/RCT.0b013e3181a7e2a8
    1. Leng KM, Wang ZD, Zhao JB, et al. . Impact of pancreatic margin status and lymph node metastases on recurrence after resection for invasive and noninvasive intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis. Dig Surg 2012;29:213–25. 10.1159/000339334
    1. Miller JR, Meyer JE, Waters JA, et al. . Outcome of the pancreatic remnant following segmental pancreatectomy for non-invasive intraductal papillary mucinous neoplasm. HPB (Oxford) 2011;13:759–66. 10.1111/j.1477-2574.2011.00354.x
    1. Moriya T, Traverso W. Fate of the pancreatic remnant after resection for an intraductal papillary mucinous neoplasm: a longitudinal level II cohort study. Arch Surg 2012;147:528–34. 10.1001/archsurg.2011.2276
    1. Bhardwaj N, Dennison AR, Maddern GJ, et al. . Management implications of resection margin histology in patients undergoing resection for IPMN: a meta-analysis. Pancreatology 2016;16:309–17. 10.1016/j.pan.2016.02.008
    1. Kang MJ, Jang JY, Lee KB, et al. . Long-term prospective cohort study of patients undergoing pancreatectomy for intraductal papillary mucinous neoplasm of the pancreas: implications for postoperative surveillance. Ann Surg 2014;260:356–63. 10.1097/SLA.0000000000000470
    1. Frankel TL, LaFemina J, Bamboat ZM, et al. . Dysplasia at the surgical margin is associated with recurrence after resection of non-invasive intraductal papillary mucinous neoplasms. HPB (Oxford) 2013;15:814–21. 10.1111/hpb.12137
    1. Xourafas D, Tavakkoli A, Clancy TE, et al. . Noninvasive intraductal papillary mucinous neoplasms and mucinous cystic neoplasms: recurrence rates and postoperative imaging follow-up. Surgery 2015;157:473–83. 10.1016/j.surg.2014.09.028
    1. Yogi T, Hijioka S, Imaoka H, et al. . Risk factors for postoperative recurrence of intraductal papillary mucinous neoplasms of the pancreas based on a long-term follow-up study: proposals for follow-up strategies. J Hepatobiliary Pancreat Sci 2015;22:757–65. 10.1002/jhbp.280
    1. Raut CP, Cleary KR, Staerkel GA, et al. . Intraductal papillary mucinous neoplasms of the pancreas: effect of invasion and pancreatic margin status on recurrence and survival. Ann Surg Oncol 2006;13:582–94. 10.1245/ASO.2006.05.002
    1. Eguchi H, Ishikawa O, Ohigashi H, et al. . Role of intraoperative cytology combined with histology in detecting continuous and skip type intraductal cancer existence for intraductal papillary mucinous carcinoma of the pancreas. Cancer 2006;107:2567–75. 10.1002/cncr.22301
    1. Farrell JJ, Fernández-del Castillo C. Pancreatic cystic neoplasms: management and unanswered questions. Gastroenterology 2013;144:1303–15. 10.1053/j.gastro.2013.01.073
    1. Kaneko T, Nakao A, Nomoto S, et al. . Intraoperative pancreatoscopy with the ultrathin pancreatoscope for mucin-producing tumors of the pancreas. Arch Surg 1998;133:263–7. 10.1001/archsurg.133.3.263
    1. Pucci MJ, Johnson CM, Punja VP, et al. . Intraoperative pancreatoscopy: a valuable tool for pancreatic surgeons? J Gastrointest Surg 2014;18:1100–7. 10.1007/s11605-014-2501-9
    1. Yokoyama Y, Nagino M, Oda K, et al. . Clinicopathologic features of re-resected cases of intraductal papillary mucinous neoplasms (IPMNs). Surgery 2007;142:136–42. 10.1016/j.surg.2007.03.006
    1. Cuillerier E, Cellier C, Palazzo L, et al. . Outcome after surgical resection of intraductal papillary and mucinous tumors of the pancreas. Am J Gastroenterol 2000;95:441–5. 10.1111/j.1572-0241.2000.01764.x
    1. 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;239:678–85. discussion 85-7.
    1. Piciucchi M, Crippa S, Del Chiaro M, et al. . Outcomes of intraductal papillary mucinous neoplasm with "Sendai-positive" criteria for resection undergoing non-operative management. Dig Liver Dis 2013;45:584–8. 10.1016/j.dld.2013.01.016
    1. Ammori JB, Do RK, Brennan MF, et al. . Uncinate duct dilation in intraductal papillary mucinous neoplasms of the pancreas: a radiographic finding with potentially increased malignant potential. J Gastrointest Surg 2014;18:911–6. 10.1007/s11605-014-2449-9
    1. Marchegiani G, Mino-Kenudson M, Ferrone CR, et al. . Oncocytic-type intraductal papillary mucinous neoplasms: a unique malignant pancreatic tumor with good long-term prognosis. J Am Coll Surg 2015;220:839–44. 10.1016/j.jamcollsurg.2015.01.051
    1. Paini M, Crippa S, Scopelliti F, et al. . Extent of surgery and implications of transection margin status after resection of IPMNs. Gastroenterol Res Pract 2014;2014:1–10. 10.1155/2014/269803
    1. Ducreux M, Cuhna AS, Caramella C, et al. . Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26(suppl 5):v56–v68. 10.1093/annonc/mdv295
    1. Canto MI, Harinck F, Hruban RH, et al. . International Cancer of the Pancreas Screening (CAPS) consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut 2013;62:339–47. 10.1136/gutjnl-2012-303108
    1. Konings IC, Harinck F, Poley JW, et al. . Prevalence and progression of pancreatic cystic precursor lesions differ between groups at high risk of developing pancreatic cancer. Pancreas 2017;46:28–34. 10.1097/MPA.0000000000000725
    1. Bartsch DK, Slater EP, Carrato A, et al. . Refinement of screening for familial pancreatic cancer. Gut 2016;65:1314–21. 10.1136/gutjnl-2015-311098
    1. Vasen H, Ibrahim I, Ponce CG, et al. . Benefit of surveillance for pancreatic cancer in high-risk individuals: outcome of long-term prospective follow-up studies from three European expert centers. J Clin Oncol 2016;34:2010–9. 10.1200/JCO.2015.64.0730
    1. Agarwal A, Scott FI, Ahmad NA, et al. . Chronic immunosuppression does not potentiate the malignant progression of mucinous pancreatic cystic lesions. Pancreatology 2016;16:900–4. 10.1016/j.pan.2016.07.001
    1. Dorfman V, Verna EC, Poneros JM, et al. . Progression of incidental intraductal papillary mucinous neoplasms of the pancreas in liver transplant recipients. Pancreas 2016;45:620–5. 10.1097/MPA.0000000000000510
    1. Gill KR, Pelaez-Luna M, Keaveny A, et al. . Branch duct intraductal papillary mucinous neoplasm of the pancreas in solid organ transplant recipients. Am J Gastroenterol 2009;104:1256–61. 10.1038/ajg.2009.62
    1. Lennon AM, Victor D, Zaheer A, et al. . Liver transplant patients have a risk of progression similar to that of sporadic patients with branch duct intraductal papillary mucinous neoplasms. Liver Transpl 2014;20:1462–7. 10.1002/lt.23983
    1. Vidhyarkorn S, Siripongsakun S, Yu J, et al. . Longterm follow-up of small pancreatic cystic lesions in liver transplant recipients. Liver Transpl 2017;23:324–9. 10.1002/lt.24680
    1. Oh HC, Brugge WR. EUS-guided pancreatic cyst ablation: a critical review (with video). Gastrointest Endosc 2013;77:526–33. 10.1016/j.gie.2012.10.033
    1. Oh HC, Seo DW, Song TJ, et al. . Endoscopic ultrasonography-guided ethanol lavage with paclitaxel injection treats patients with pancreatic cysts. Gastroenterology 2011;140:172–9. 10.1053/j.gastro.2010.10.001
    1. Gan SI, Thompson CC, Lauwers GY, et al. . Ethanol lavage of pancreatic cystic lesions: initial pilot study. Gastrointest Endosc 2005;61:746–52. 10.1016/S0016-5107(05)00320-2
    1. Park JK, Song BJ, Ryu JK, et al. . Clinical outcomes of endoscopic ultrasonography-guided pancreatic cyst ablation. Pancreas 2016;45:889–94. 10.1097/MPA.0000000000000567
    1. Gómez V, Takahashi N, Levy MJ, et al. . EUS-guided ethanol lavage does not reliably ablate pancreatic cystic neoplasms (with video). Gastrointest Endosc 2016;83:914–20. 10.1016/j.gie.2015.08.069
    1. Nilsson LN, Keane MG, Shamali A, et al. . Nature and management of pancreatic mucinous cystic neoplasm (MCN): a systematic review of the literature. Pancreatology 2016;16:1028–36. 10.1016/j.pan.2016.09.011
    1. Naganuma S, Honda K, Noriki S, et al. . Ruptured mucinous cystic neoplasm with an associated invasive carcinoma of pancreatic head in a pregnant woman: report of a case and review of literature. Pathol Int 2011;61:28–33. 10.1111/j.1440-1827.2010.02609.x
    1. Tanaka M, Fernández-del Castillo C, Adsay V, et al. . International consensus guidelines 2012 for the management of IPMN and MCN of the pancreas. Pancreatology 2012;12:183–97. 10.1016/j.pan.2012.04.004
    1. Crippa S, Fernández-Del Castillo C, Salvia R, et al. . Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics. Clin Gastroenterol Hepatol 2010;8:213–9. 10.1016/j.cgh.2009.10.001
    1. Iacono C, Verlato G, Ruzzenente A, et al. . Systematic review of central pancreatectomy and meta-analysis of central versus distal pancreatectomy. Br J Surg 2013;100:873–85. 10.1002/bjs.9136
    1. Mehrabi A, Hafezi M, Arvin J, et al. . A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas: it’s time to randomize. Surgery 2015;157:45–55. 10.1016/j.surg.2014.06.081
    1. Jais B, Rebours V, Malleo G, et al. . Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 2016;65:305–12. 10.1136/gutjnl-2015-309638
    1. Reid MD, Choi HJ, Memis B, et al. . Serous neoplasms of the pancreas: a clinicopathologic analysis of 193 cases and literature review with new insights on macrocystic and solid variants and critical reappraisal of so-called "serous cystadenocarcinoma". Am J Surg Pathol 2015;39:1597–610. 10.1097/PAS.0000000000000559
    1. Strobel O, Z’graggen K, Schmitz-Winnenthal FH, et al. . Risk of malignancy in serous cystic neoplasms of the pancreas. Digestion 2003;68:24–33. 10.1159/000073222
    1. Galanis C, Zamani A, Cameron JL, et al. . Resected serous cystic neoplasms of the pancreas: a review of 158 patients with recommendations for treatment. J Gastrointest Surg 2007;11:820–6. 10.1007/s11605-007-0157-4
    1. Khashab MA, Shin EJ, Amateau S, et al. . Tumor size and location correlate with behavior of pancreatic serous cystic neoplasms. Am J Gastroenterol 2011;106:1521–6. 10.1038/ajg.2011.117
    1. Pelaez-Luna MC, Moctezuma-Velázquez C, Hernández-Calleros J, et al. . Serous cystadenomas follow a benign and asymptomatic course and do not present a significant size change during follow-up. Rev Invest Clin 2015;67:344–9.
    1. Reid MD, Choi H, Balci S, et al. . Serous cystic neoplasms of the pancreas: clinicopathologic and molecular characteristics. Semin Diagn Pathol 2014;31:475–83. 10.1053/j.semdp.2014.08.009
    1. El-Hayek KM, Brown N, O’Rourke C, et al. . Rate of growth of pancreatic serous cystadenoma as an indication for resection. Surgery 2013;154:794–802. discussion -2 10.1016/j.surg.2013.07.005
    1. Malleo G, Bassi C, Rossini R, et al. . Growth pattern of serous cystic neoplasms of the pancreas: observational study with long-term magnetic resonance surveillance and recommendations for treatment. Gut 2012;61:746–51. 10.1136/gutjnl-2011-300297
    1. Menard A, Tomlinson G, Cleary S, et al. . Serous cystadenomas of the pancreas: long-term follow-up measurement of growth rate. Can Assoc Radiol J 2011;62:190–6. 10.1016/j.carj.2010.04.004
    1. Chalian H, Töre HG, Rezai P, et al. . MDCT evaluation of the growth kinetics of serous and benign mucinous cystic neoplasms of the pancreas. Cancer Imaging 2011;11:116–22. 10.1102/1470-7330.2011.0019
    1. Das A, Wells CD, Nguyen CC. Incidental cystic neoplasms of pancreas: what is the optimal interval of imaging surveillance? Am J Gastroenterol 2008;103:1657–62. 10.1111/j.1572-0241.2008.01893.x
    1. Tseng JF, Warshaw AL, Sahani DV, et al. . Serous cystadenoma of the pancreas: tumor growth rates and recommendations for treatment. Ann Surg 2005;242:413–9. discussion 9-21.
    1. Bassi C, Salvia R, Molinari E, et al. . Management of 100 consecutive cases of pancreatic serous cystadenoma: wait for symptoms and see at imaging or vice versa? World J Surg 2003;27:319–23. 10.1007/s00268-002-6570-7
    1. Morris-Stiff G, Falk GA, Chalikonda S, et al. . Natural history of asymptomatic pancreatic cystic neoplasms. HPB (Oxford) 2013;15:175–81. 10.1111/j.1477-2574.2012.00522.x
    1. Kim MJ, Choi DW, Choi SH, et al. . Surgical treatment of solid pseudopapillary neoplasms of the pancreas and risk factors for malignancy. Br J Surg 2014;101:1266–71. 10.1002/bjs.9577
    1. Cai Y, Ran X, Xie S, et al. . Surgical management and long-term follow-up of solid pseudopapillary tumor of pancreas: a large series from a single institution. J Gastrointest Surg 2014;18:935–40. 10.1007/s11605-014-2476-6
    1. Wang WB, Zhang TP, Sun MQ, et al. . Solid pseudopapillary tumor of the pancreas with liver metastasis: clinical features and management. Eur J Surg Oncol 2014;40:1572–7. 10.1016/j.ejso.2014.05.012
    1. Cheng K, Shen B, Peng C, et al. . Synchronous portal-superior mesenteric vein or adjacent organ resection for solid pseudopapillary neoplasms of the pancreas: a single-institution experience. Am Surg 2013;79:534–9.
    1. Lee HS, Kim HK, Shin BK, et al. . A rare case of recurrent metastatic solid pseudopapillary neoplasm of the pancreas. J Pathol Transl Med 2017;51:87–91. 10.4132/jptm.2016.06.16
    1. Kawamoto S, Johnson PT, Shi C, et al. . Pancreatic neuroendocrine tumor with cystlike changes: evaluation with MDCT. AJR Am J Roentgenol 2013;200:W283–90. 10.2214/AJR.12.8941
    1. Park HS, Kim SY, Hong SM, et al. . Hypervascular solid-appearing serous cystic neoplasms of the pancreas: differential diagnosis with neuroendocrine tumours. Eur Radiol 2016;26:1348–58. 10.1007/s00330-015-3961-3
    1. Jang KM, Kim SH, Song KD, et al. . Differentiation of solid-type serous cystic neoplasm from neuroendocrine tumour in the pancreas: value of abdominal MRI with diffusion-weighted imaging in comparison with MDCT. Clin Radiol 2015;70:153–60. 10.1016/j.crad.2014.10.010
    1. Koh YX, Chok AY, Zheng HL, et al. . A systematic review and meta-analysis of the clinicopathologic characteristics of cystic versus solid pancreatic neuroendocrine neoplasms. Surgery 2014;156:83–96. 10.1016/j.surg.2014.03.026
    1. Partelli S, Cirocchi R, Crippa S, et al. . Systematic review of active surveillance versus surgical management of asymptomatic small non-functioning pancreatic neuroendocrine neoplasms. Br J Surg 2017;104:34–41. 10.1002/bjs.10312
    1. Akbulut S, Yavuz R, Sogutcu N, et al. . Hydatid cyst of the pancreas: report of an undiagnosed case of pancreatic hydatid cyst and brief literature review. World J Gastrointest Surg 2014;6:190–200. 10.4240/wjgs.v6.i10.190
    1. Mondal U, Henkes N, Henkes D, Rosenkranz L. Cavernous hemangioma of adult pancreas: a case report and literature review. World J Gastroenterol 2015;21:9793–802. 10.3748/wjg.v21.i33.9793
    1. Matsubayashi H, Aikawa Y, Sugiura T, et al. . Pancreatic lymphoepithelial cyst showing multiple floating ball-like appearances. J Gastrointestin Liver Dis 2016;25:239–42.
    1. Wolf AM, Shirley LA, Winter JM, et al. . Acinar cell cystadenoma of the pancreas: report of three cases and literature review. J Gastrointest Surg 2013;17:1322–6. 10.1007/s11605-013-2199-0
    1. Albayrak A, Yildirim U, Aydin M. Dermoid cyst of the pancreas: a report of an unusual case and a review of the literature. Case Rep Pathol 2013;2013:1–5. 10.1155/2013/375193
    1. Dong F, Zheng Y, Wu JJ, et al. . Hemolymphangioma: a rare differential diagnosis of cystic-solid or cystic tumors of the pancreas. World J Gastroenterol 2013;19:3520–3. 10.3748/wjg.v19.i22.3520
    1. Kim YS, Cho JH. Rare nonneoplastic cysts of pancreas. Clin Endosc 2015;48:31–8. 10.5946/ce.2015.48.1.31
    1. Otsuka T, Morizane C, Nara S, et al. . Gemcitabine in patients with intraductal papillary mucinous neoplasm with an associated invasive carcinoma of the pancreas. Pancreas 2013;42:889–92. 10.1097/MPA.0b013e3182826f1f
    1. Alexander BM, Fernandez-Del Castillo C, Ryan DP, et al. . Intraductal papillary mucinous adenocarcinoma of the pancreas: clinical outcomes, prognostic factors, and the role of adjuvant therapy. Gastrointest Cancer Res 2011;4:116–21.
    1. Worni M, Akushevich I, Gloor B, et al. . Adjuvant radiotherapy in the treatment of invasive intraductal papillary mucinous neoplasm of the pancreas: an analysis of the surveillance, epidemiology, and end results registry. Ann Surg Oncol 2012;19:1316–23. 10.1245/s10434-011-2088-2
    1. Turrini O, Waters JA, Schnelldorfer T, et al. . Invasive intraductal papillary mucinous neoplasm: predictors of survival and role of adjuvant therapy. HPB 2010;12:447–55. 10.1111/j.1477-2574.2010.00196.x
    1. Wasif N, Bentrem DJ, Farrell JJ, et al. . Invasive intraductal papillary mucinous neoplasm versus sporadic pancreatic adenocarcinoma: a stage-matched comparison of outcomes. Cancer 2010;116:3369–77. 10.1002/cncr.25070
    1. Swartz MJ, Hsu CC, Pawlik TM, et al. . Adjuvant chemoradiotherapy after pancreatic resection for invasive carcinoma associated with intraductal papillary mucinous neoplasm of the pancreas. Int J Radiat Oncol Biol Phys 2010;76:839–44. 10.1016/j.ijrobp.2009.02.071
    1. Le H, Ziogas A, Rhee JM, et al. . A population-based, descriptive analysis of malignant intraductal papillary mucinous neoplasms of the pancreas. Cancer Epidemiol Biomarkers Prev 2008;17:2737–41. 10.1158/1055-9965.EPI-08-0417
    1. Caponi S, Vasile E, Funel N, et al. . Adjuvant chemotherapy seems beneficial for invasive intraductal papillary mucinous neoplasms. Eur J Surg Oncol 2013;39:396–403. 10.1016/j.ejso.2012.12.005
    1. McMillan MT, Lewis RS, Drebin JA, et al. . The efficacy of adjuvant therapy for pancreatic invasive intraductal papillary mucinous neoplasm (IPMN). Cancer 2016;122:521–33. 10.1002/cncr.29803
    1. Fong ZV, Castillo CF. Intraductal papillary mucinous adenocarcinoma of the pancreas: clinical outcomes, prognostic factors, and the role of adjuvant therapy. Viszeralmedizin 2015;31:43–6. 10.1159/000373912
    1. Hirono S, Tani M, Kawai M, et al. . Treatment strategy for intraductal papillary mucinous neoplasm of the pancreas based on malignant predictive factors. Arch Surg 2009;144:345–9. discussion 9-50 10.1001/archsurg.2009.2
    1. Yachha SK, Chetri K, Saraswat VA, et al. . Management of childhood pancreatic disorders: a multidisciplinary approach. J Pediatr Gastroenterol Nutr 2003;36:206–12. 10.1097/00005176-200302000-00009
    1. Maire F, Hammel P, Terris B, et al. . Prognosis of malignant intraductal papillary mucinous tumours of the pancreas after surgical resection. Comparison with pancreatic ductal adenocarcinoma. Gut 2002;51:717–22. 10.1136/gut.51.5.717
    1. Le Borgne J, de Calan L, Partensky C. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann Surg 1999;230:152–61.
    1. Westermark S, Rangelova E, Ansorge C, et al. . Cattell-Braasch maneuver combined with local hypothermia during superior mesenteric artery resection in pancreatectomy. Langenbecks Arch Surg 2016;401:1241–7. 10.1007/s00423-016-1501-5
    1. Di Marco M, Vecchiarelli S, Macchini M, et al. . Preoperative gemcitabine and oxaliplatin in a patient with ovarian metastasis from pancreatic cystadenocarcinoma. Case Rep Gastroenterol 2012;6:530–7. 10.1159/000341513
    1. Sacco Casamassima MG, Gause CD, Goldstein SD, et al. . Pancreatic surgery for tumors in children and adolescents. Pediatr Surg Int 2016;32:779–88. 10.1007/s00383-016-3925-y
    1. Prasad TV, Madhusudhan KS, Srivastava DN, et al. . Transarterial chemoembolization for liver metastases from solid pseudopapillary epithelial neoplasm of pancreas: a case report. World J Radiol 2015;7:61–5. 10.4329/wjr.v7.i3.61
    1. Hofmann H, von Haken R, Werner J, et al. . Unresectable isolated hepatic metastases from solid pseudopapillary neoplasm of the pancreas: a case report of chemosaturation with high-dose melphalan. Pancreatology 2014;14:546–9. 10.1016/j.pan.2014.08.006
    1. Honore C, Goere D, Dartigues P, et al. . Peritoneal carcinomatosis from solid pseudopapillary neoplasm (Frantz’s tumour) of the pancreas treated with HIPEC. Anticancer Res 2012;32:1069–73.
    1. Ansari D, Elebro J, Tingstedt B, et al. . Single-institution experience with solid pseudopapillary neoplasm of the pancreas. Scand J Gastroenterol 2011;46:1492–7. 10.3109/00365521.2011.627448
    1. Maffuz A, Bustamante FT, Silva JA, et al. . Preoperative gemcitabine for unresectable, solid pseudopapillary tumour of the pancreas. Lancet Oncol 2005;6:185–6. 10.1016/S1470-2045(05)01770-5
    1. Matsuda Y, Imai Y, Kawata S, et al. . Papillary-cystic neoplasm of the pancreas with multiple hepatic metastases: a case report. Gastroenterol Jpn 1987;22:379–84.
    1. Valente R, Capurso G, Pierantognetti P, et al. . Simultaneous intraductal papillary neoplasms of the bile duct and pancreas treated with chemoradiotherapy. World J Gastrointest Oncol 2012;4:22–5. 10.4251/wjgo.v4.i2.22
    1. Irtan S, Galmiche-Rolland L, Elie C, et al. . Recurrence of solid pseudopapillary neoplasms of the pancreas: results of a nationwide study of risk factors and treatment modalities. Pediatr Blood Cancer 2016;63:1515–21. 10.1002/pbc.25986
    1. Esposito I, Kleeff J, Bergmann F, et al. . Most pancreatic cancer resections are R1 resections. Ann Surg Oncol 2008;15:1651–60. 10.1245/s10434-008-9839-8
    1. Verbeke CS, Gladhaug IP. Dissection of pancreatic resection specimens. Surg Pathol Clin 2016;9:523–38. 10.1016/j.path.2016.05.001
    1. Adsay V, Mino-Kenudson M, Furukawa T, et al. . Pathologic evaluation and reporting of intraductal papillary mucinous neoplasms of the pancreas and other tumoral intraepithelial neoplasms of pancreatobiliary tract. Ann Surg 2016;263:162–77. 10.1097/SLA.0000000000001173
    1. Basturk O, Hong SM, Wood LD, et al. . A revised classification system and recommendations from the Baltimore consensus meeting for neoplastic precursor lesions in the pancreas. Am J Surg Pathol 2015;39:1730–41. 10.1097/PAS.0000000000000533
    1. Furukawa T, Klöppel G, Volkan Adsay N, et al. . Classification of types of intraductal papillary-mucinous neoplasm of the pancreas: a consensus study. Virchows Arch 2005;447:794–9. 10.1007/s00428-005-0039-7
    1. 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. 10.1136/gut.2010.210567
    1. Brierley JD, Gospodarowicz MK, Wittenkind CH, TNM classification of malignant tumours. 8th edn: Wiley-Blackwell, 2017:272.
    1. Distler M, Kersting S, Niedergethmann M, et al. . Pathohistological subtype predicts survival in patients with intraductal papillary mucinous neoplasm (IPMN) of the pancreas. Ann Surg 2013;258:324–30. 10.1097/SLA.0b013e318287ab73
    1. Scourtas A, Dudley JC, Brugge WR, et al. . Preoperative characteristics and cytological features of 136 histologically confirmed pancreatic mucinous cystic neoplasms. Cancer Cytopathol 2017;125:169–77. 10.1002/cncy.21806
    1. Pitman MB, Yaeger KA, Brugge WR, et al. . Prospective analysis of atypical epithelial cells as a high-risk cytologic feature for malignancy in pancreatic cysts. Cancer Cytopathol 2013;121:29–36. 10.1002/cncy.21242
    1. Pitman MB, Centeno BA, Ali SZ, et al. . Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology guidelines. Diagn Cytopathol 2014;42:338–50. 10.1002/dc.23092

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