Alghamdi TH. When to operate pancreatic intraductal papillary mucinous neoplasm: Literature review. World J Clin Oncol 2026; 17(3): 114990 [DOI: 10.5306/wjco.v17.i3.114990]
Corresponding Author of This Article
Thamer H Alghamdi, Associate Professor, Consultant, Department of Surgery, Al-Baha University, King Fahad Street, Al Baha 65716, Saudi Arabia. tthaker@bu.edu.sa
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
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World J Clin Oncol. Mar 24, 2026; 17(3): 114990 Published online Mar 24, 2026. doi: 10.5306/wjco.v17.i3.114990
When to operate pancreatic intraductal papillary mucinous neoplasm: Literature review
Thamer H Alghamdi
Thamer H Alghamdi, Department of Surgery, Al-Baha University, Al Baha 65716, Saudi Arabia
Author contributions: Alghamdi TH was responsible for study design, collecting data, data analysis, and writing the paper.
Conflict-of-interest statement: Author declares no conflict of interest in publishing the manuscript.
Corresponding author: Thamer H Alghamdi, Associate Professor, Consultant, Department of Surgery, Al-Baha University, King Fahad Street, Al Baha 65716, Saudi Arabia. tthaker@bu.edu.sa
Received: October 11, 2025 Revised: December 6, 2025 Accepted: January 27, 2026 Published online: March 24, 2026 Processing time: 170 Days and 19.8 Hours
Abstract
Management of intraductal papillary mucinous neoplasms (IPMNs) is debated due to differing guidelines. The aim is to identify the timing of surgery and follow-up, as well as how to prioritize the imaging technique. We reviewed all IPMNs guidelines. Sendai guidelines recommended surgical resection for all main duct IPMNs and mixed-type IPMNs if the patient is healthy resulting in increased morbidity and mortality. International Association of Pancreatology Fukuoka guidelines introduced “worrisome feature” and “high-risk stigmata (HRS)”. International Consensus Guidelines recommended that surgery for all cases of main duct IPMNs with a main pancreatic diameter of more than 10 mm or associated with HRS. European Experts Consensus statement guidelines revealed absolute and relative indications for surgery of cases with high-risk IPMNs, considering the size of the cyst with a cut-off point of 4 cm. Fukuoka’s definitions of HRS and worrisome feature and planned the surgery for all mucinous type. American Gastroenterological Association guidelines restricted surgery for non-symptomatic patients. European guidelines recommend surgery in presence of jaundice, an enhanced mural nodule ≥ 5 mm, or have a solid component, positive malignancy and others. Although most of these guidelines showed agreement on the timing of surgery types of IPMNs, there are still debates about the timing of surveillance/follow-up and selection/prioritization of the imaging technique, despite new trials have emerged.
Core Tip: The importance of this literature review lies in clarifying the timing of surgery and surveillance across divergent consensus statements, highlighting areas of agreement and persistent controversy. Its value lies in distilling and juxtaposing guideline trajectories to expose an implicit hypothesis: That moving from the aggressive approach to the more restrictive, feature-based strategies that reduced unnecessary resections without increasing missed cancers.
