Table 3.

Indications for surgical resection of intraductal papillary mucinous neoplasm by different guidelines.

Guidelines	AGA (2015)[20]	IAP (2017)[8]	European (2018)[9]
Absolute indications	• PD dilatation ≥ 5 mm	• Positive or suspicious cytology results for malignancy	• Positive cytology results for malignancy or high-grade dysplasia
			• Enhancing mural nodule ≥ 5 mm
		• Enhancing mural nodule ≥ 5 mm
	• Solid portion or positive cytology results for malignancy
		• PD dilatation ≥ 10 mm
		• Jaundice related with IPMN	• PD dilatation ≥ 10 mm
			• Solid portion
			• Jaundice related with IPMN
Relative indications	-	• Growth rate ≥ 5 mm/2 yr	• Growth rate ≥ 5 mm/2 yr
		• Serum CA 19-9 level↑
			• Serum CA 19–9 level↑
		• PD dilatation 5–9 mm
		• Cyst diameter ≥ 30 mm	• PD dilatation 5–9.9 mm
		• Enhancing mural nodule < 5 mm
			• Cyst diameter ≥ 40 mm
		• Lymphadenopathy
		• Abrupt change of PD diameter and distal pancreatic atrophy	• Enhancing mural nodule < 5 mm
		• Thickened or enhancing wall of cyst	• New-onset diabetes mellitus
		• Acute pancreatitis caused by IPMN	• Acute pancreatitis caused by IPMN

AGA = American Gastroenterological Association Institute Guideline on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts, CA 19-9, carbohydrate antigen 19-9, European = European evidence-based guidelines on pancreatic cystic neoplasms, IAP = Revisions of International Consensus Fukuoka Guidelines for the Management of IPMN of the pancreas, IPMN = intraductal papillary mucinous neoplasm, PD = pancreatic duct.