Can neoplastic cystic masses in the head of the pancreas be safely and adequately removed without a whipple resection?

The minimal increase in operative mortality and long-term morbidity rates associated with pancreaticoduodenectomy compared with enucleation should not justify broad adoption of this oncologically inadequate operation for cystic neoplasms in the head of the pancreas. With the current state of both preoperative and intraoperative diagnostic techniques, even the best clinicians may not be able to reliably distinguish between benign and malignant cystic neoplasms. This risks the enucleation of a malignant cystic neoplasm and the lost chance for a curative resection. Enucleation of a side branch IPMN deprives the surgeon and the patient of information about the extent of the disease and the ability to eradicate more advanced disease that could progress to invasive malignancy. Thus, IPMN should not be managed in this fashion.