{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T11:47:07Z","timestamp":1747223227464,"version":"3.40.5"},"reference-count":0,"publisher":"Pensoft Publishers","issue":"6","license":[{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FM"],"abstract":"<jats:p>Intraductal papillary mucinous neoplasm (IPMN)&amp;nbsp;of the pancreas is a relatively new entity that has gained increased attention because of its unique features &amp;ndash; presence of different subtypes with different malignant potential, biological behavior, and prognosis, higher rates of recurrences and concomitant or metachronous pancreatic duct cancer. It is rare with an incidence of 4 to 5 cases per 100&amp;nbsp;000. The relative lack of experience significantly hampers decision making for surgery (pancreatic head resection, distal pancreatectomy or enucleation) or follow-up.<\/jats:p>\n          <jats:p>Herein we present two cases managed by diametrically different tactic according to the risk stratification &amp;ndash; distal pancreatectomy with splenectomy and observation, respectively. An up-to-date literature review on the key points in diagnostics, indications for surgery, the extent of surgery, follow-up, and prognosis is provided.<\/jats:p>\n          <jats:p>The tailored approach based on risk stratification is the cornerstone of management. Absolute indications for surgery are the lesions with high-risk stigmata, whereas the worrisome features should be evaluated by endoscopic ultrasound and fine-needle aspiration. Main duct and mixed type are usually referred to surgery, whereas the management of a branch type is more conservative due to the lower rate of invasive cancer. Strict postoperative follow-up is mandatory even in negative resection margins due to a high risk for recurrences and metachronous lesions.<\/jats:p>\n          <jats:p>Despite the guidelines, the intraductal papillary mucinous neoplasm remains a major challenge for clinicians and surgeons in the balance the risk\/benefit of observation versus resection. Risk stratification plays a key role in decision-making. Future trials need to determine the optimal period of surveillance and the most reliable predictive factors for concomitant pancreatic duct cancer.<\/jats:p>","DOI":"10.3897\/folmed.63.e63071","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T08:30:55Z","timestamp":1640939455000},"page":"970-976","source":"Crossref","is-referenced-by-count":0,"title":["Intraductal Papillary Mucinous Neoplasm&amp;nbsp;of the Pancreas: Need for a Tailored Approach to a Rare Entity"],"prefix":"10.3897","volume":"63","author":[{"given":"Marina","family":"Konaktchieva","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitar","family":"Penchev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9618-3187","authenticated-orcid":true,"given":"Georgi","family":"Popivanov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lilia","family":"Vladova","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roberto","family":"Cirocchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marin","family":"Penkov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2297-547X","authenticated-orcid":true,"given":"Petko","family":"Karagyozov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ventsislav","family":"Mutafchiyski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2258","published-online":{"date-parts":[[2021,12,31]]},"container-title":["Folia Medica"],"original-title":[],"link":[{"URL":"https:\/\/foliamedica.bg\/article\/63071\/download\/pdf\/","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/foliamedica.bg\/article\/63071\/download\/xml\/","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/foliamedica.bg\/article_preview.php?id=63071&skip_redirect=1","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,4]],"date-time":"2022-01-04T13:39:04Z","timestamp":1641303544000},"score":1,"resource":{"primary":{"URL":"https:\/\/foliamedica.bg\/article\/63071\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,31]]},"references-count":0,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,12,31]]}},"URL":"https:\/\/doi.org\/10.3897\/folmed.63.e63071","relation":{},"ISSN":["1314-2143","0204-8043"],"issn-type":[{"type":"electronic","value":"1314-2143"},{"type":"print","value":"0204-8043"}],"subject":[],"published":{"date-parts":[[2021,12,31]]}}}