Danish Pancreatic Cancer Group consensus guidelines on the management of pancreatic IPMN

BackgroundIntraductal papillary mucinous neoplasms (IPMNs) are the most common pancreatic cystic neoplasms and are increasingly detected incidentally. Although they carry malignant potential, most lesions follow an indolent course, creating a clinical challenge in balancing early cancer detection with the risks of overtreatment. Existing international guidelines differ in surveillance strategies, thresholds for intervention, and recommendations for discontinuation.PurposeTo present Danish multidisciplinary consensus recommendations for the evaluation, surveillance, and management of pancreatic intraductal papillary mucinous neoplasms.Material and MethodsThe Danish Pancreatic Cancer Group consensus was developed by a multidisciplinary working group comprising radiologists and pancreatic surgeons. Recommendations were based on a narrative review of the literature, existing international guidelines, and clinical experience within a centralized healthcare setting. Consensus was achieved through iterative discussions without a formal Delphi process.RecommendationsMagnetic resonance imaging with MR cholangiopancreatography (MRI/MRCP) is recommended as the primary modality for diagnosis and surveillance, with computed tomography and endoscopic ultrasound used selectively. Risk stratification is based on high-risk stigmata and worrisome features, with emphasis on interval changes during follow-up. Surveillance strategies are primarily size-based and individualized according to patient age, comorbidities, and surgical eligibility. Surgical evaluation is recommended for cysts larger than 30 mm and for main-duct or mixed-type IPMNs with high-risk features, while a more selective approach is applied to branch-duct IPMN. Discontinuation of surveillance is supported in selected patients with stable disease, particularly in older individuals.ConclusionThe Danish multidisciplinary consensus provides a pragmatic, risk-adapted approach to IPMN management, emphasizing individualized care, multidisciplinary decision-making, and avoidance of unnecessary investigations and surgical overtreatment.