IPMN Surgery vs Surveillance: Annals of Surgical Oncology | April 2026

Introduction

Intraductal papillary mucinous neoplasm presents a common yet challenging clinical dilemma—whether to operate or observe. The core issue is diagnostic uncertainty, as current imaging and clinical tools cannot reliably identify which lesions harbor high-grade dysplasia or invasive cancer. This creates a high-stakes decision environment where both overtreatment and undertreatment are real risks.

Problem Statement

There is significant uncertainty and variability in decision-making for IPMN due to inability to accurately predict malignancy risk, combined with differing patient and clinician perspectives.

Summary

This perspective strongly emphasizes that IPMN management is not purely a clinical algorithm but a preference-sensitive decision under uncertainty. Surgeons often differ in their thresholds for recommending surgery, while patients vary widely in their tolerance for cancer risk, fear of surgery, and willingness to undergo long-term surveillance.

The article proposes shared decision-making (SDM) as the solution—integrating three essential components: individualized risk estimation, clear communication of trade-offs between surgery and surveillance, and elicitation of patient values. SDM helps align treatment decisions with what matters most to the patient rather than relying solely on physician-driven judgment.

The key message is powerful and practical:

👉 In IPMN, the “right” decision is not universal—it depends on the patient.

This framework promotes better risk communication, reduces unwarranted variation, and supports more patient-centered care while maintaining clinical expertise.