In this issue of JAMA Surgery, Hu and colleagues1 examined the question of early resection vs continued radiologic surveillance for the subset of patients who presented with branch duct intraductal papillary mucinous neoplasms with “worrisome” features, using Markov modeling for comparative effectiveness. Their findings demonstrate that an early surgical approach compares favorably with observation, provided certain patient, surgeon, and disease factors are met. This study can serve as template for surgical recommendations for a challenging group of patients who face relatively risky, life-altering operations for a disease process with uncertain malignant potential.
Salila S. Hashmi, David A. Kooby. Branch Duct Intraductal Papillary Mucinous NeoplasmsHow Worried Should We Be About Worrisome Features?. JAMA Surg. Published online November 22, 2017. doi:10.1001/jamasurg.2017.4588