# Revised international consensus Fukuoka guidelines for the management of IPMN of the pancreas (2017)

Source: https://onco.cc/key-papers/paper-fukuoka-2017-consensus-guidelines-ipmn-pancreatology-2017/  
OnCo record `paper-fukuoka-2017-consensus-guidelines-ipmn-pancreatology-2017` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The international rulebook for pancreatic cysts: which features mean a cyst should be removed straight away (high-risk stigmata), which mean it needs a closer look with endoscopic ultrasound (worrisome features), and how often smaller cysts should be scanned.

## Summary

Revision of the 2012 Fukuoka consensus from the International Association of Pancreatology for intraductal papillary mucinous neoplasms and mucinous cystic neoplasms. High-risk stigmata that indicate resection are obstructive jaundice from a cyst in the head, an enhancing mural nodule of 5 mm or more and a main pancreatic duct of 10 mm or more. Worrisome features that indicate endoscopic ultrasound include cyst size of 3 cm or more, enhancing mural nodule under 5 mm, thickened enhancing cyst walls, main duct 5 to 9 mm, abrupt change in duct calibre with distal atrophy, lymphadenopathy, raised CA19-9 and cyst growth of 5 mm or more in two years.

Surveillance intervals for cysts without these features are set by cyst size, and the revision addresses surgery for main-duct IPMN, extent of resection and follow-up after resection.

## Fields

- Kind: Key paper
- Last checked: 2026-09-21
- Journal: Pancreatology
- Year: 2017
- DOI: 10.1016/j.pan.2017.07.007
- Authors: Tanaka M, Fernández-Del Castillo C, Kamisawa T, et al.
- Findings: High-risk stigmata for resection: obstructive jaundice, enhancing mural nodule 5 mm or more, main duct 10 mm or more.; Worrisome features for endoscopic ultrasound: cyst 3 cm or more, small nodule, thickened wall, main duct 5 to 9 mm, raised CA19-9, growth 5 mm in two years, among others.; Size-based surveillance intervals for cysts without worrisome features.
- What it means: Most radiology reports and surgical decisions on pancreatic cysts still follow the Fukuoka criteria or their 2024 Kyoto revision.
- Caveats: Expert consensus resting on retrospective series; no randomised trial of surveillance strategies exists.; The criteria are sensitive but not specific, so many resected cysts turn out to be low grade.

## Sources

- Pancreatology 2017: https://doi.org/10.1016/j.pan.2017.07.007
- PubMed: https://pubmed.ncbi.nlm.nih.gov/28735806/

## Connected records

- cancers: [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)

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