Enucleation of Pancreatic Cystadenomas

Ge, Chunlin; Luo, Xiao; Chen, Xuchun; Ke, Guo

doi:10.1007/s11605-009-1023-3

Cited by 15 publications

(16 citation statements)

References 17 publications

(11 reference statements)

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“…Distal pancreatectomy (DP) is considered to be the procedure of choice as it yields a high rate of cure in several series (5,10,11,15,16,17,18,19,20,21). However, DP exposes patients to the risk of secondary diabetes and exocrine secretion deficit especially in the context of MEN1, for which additional surgery is frequently required (22,23). Enucleation (E) may be an attractive pancreatic parenchyma-sparing alternative strategy and is proposed by several authors in the case of a single or dominant pNEN (24,25).…”

Section: Introductionmentioning

confidence: 99%

Long-term results of the surgical management of insulinoma patients with MEN1: a Groupe d'étude des Tumeurs Endocrines (GTE) retrospective study

Vezzosi

Cardot-Bauters

Bouscaren

et al. 2015

European Journal of Endocrinology

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Objective: Management of insulinomas in the context of MEN1 remains poorly studied. The aim of this study was to evaluate long-term results of various surgical approaches in a large cohort of insulinoma-MEN1 patients. Design and methods: Consecutive insulinoma-MEN1 patients operated on for a nonmetastatic insulinoma between 1957 and 2010 were retrospectively selected from the MEN1 database of the French Endocrine Tumor Group. The type of surgery was categorized as distal pancreatectomy (DP), total pancreatectomy/cephalic duodenopancreatectomy (TP/CDP), or enucleation (E). Primary endpoint was time until recurrence of hypoglycemia after initial surgery. Secondary endpoints were post-operative complications. Results: The study included 73 patients (median ageZ28 years). Surgical procedures were DP (nZ46), TP/CDP (nZ9), or E (nZ18). After a median post-operative follow-up of 9.0 years (inter-quartile range (IQR): 2.5-16.5 years), 60/73 patients (82.2%) remained hypoglycemia free. E and TP/CDP were associated with a higher risk of recurrent hypoglycemia episodes (unadjusted hazard ratio: 6.18 ((95% CI: 1.54-24.8); PZ0.010) for E vs DP and 9.51 ((95% CI: 1.85-48.8); PZ0.007) for TP/CDP vs DP. After adjustment for International Union against Cancer pTNM classification, enucleation remained significantly associated with a higher probability of recurrence. Long-term complications had occurred in 20 (43.5%) patients European Journal of EndocrinologyClinical Study D Vezzosi and others Surgery in insulinoma-MEN1 patients

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Section: Introductionmentioning

confidence: 99%

Long-term results of the surgical management of insulinoma patients with MEN1: a Groupe d'étude des Tumeurs Endocrines (GTE) retrospective study

Vezzosi

Cardot-Bauters

Bouscaren

et al. 2015

European Journal of Endocrinology

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“…Enucleation, which is traditionally the treatment of benign pancreatic endocrine tumours, has been practised for pancreatic cystadenomas (serous and mucinous) [38] and branch duct IPMN [39]. Tumours suitable for enucleation are the benign tumours which should be ascertained intraoperatively, small and superficial tumours where the main pancreatic duct is not expected to be jeopardised by enucleation [38] [40].…”

Section: Managementmentioning

confidence: 99%

“…Tumours suitable for enucleation are the benign tumours which should be ascertained intraoperatively, small and superficial tumours where the main pancreatic duct is not expected to be jeopardised by enucleation [38] [40]. The size suitable for enucleation is debateable and it had been estimated to be less than 4 Cm although some authors would perform enucleation for tumours up to 6 cm [29] and others would only recommend enucleation for tumours less than 2 cm [40]- [42].…”

Section: Managementmentioning

confidence: 99%

“…The size suitable for enucleation is debateable and it had been estimated to be less than 4 Cm although some authors would perform enucleation for tumours up to 6 cm [29] and others would only recommend enucleation for tumours less than 2 cm [40]- [42]. Advantages are less operating time, less blood loss, quicker recovery and preservation of more pancreatic parenchyma with less chance of endocrine and exocrine consequences compared to resection [38]. There is, however, more chance of developing pancreatic fistula with enucleation [38].…”

Section: Managementmentioning

confidence: 99%

“…Advantages are less operating time, less blood loss, quicker recovery and preservation of more pancreatic parenchyma with less chance of endocrine and exocrine consequences compared to resection [38]. There is, however, more chance of developing pancreatic fistula with enucleation [38]. Pancreatic fistula has been defined as draining more than 30 mL of amylase rich fluid a day [23], persistent draining of lipase rich fluid for 6 days [43] or radiological draining of lipase rich fluid [43].…”

Section: Managementmentioning

confidence: 99%

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Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

Elkak¹

2016

JCT

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Background: Cystic tumours of the pancreas are relatively uncommon tumours but there is an increasing awareness of their importance. Modern advances in imaging had resulted in a more prompt diagnosis of these tumours. The understanding of the pathology, clinical features, diagnosis and management of these tumours is continuously evolving. Data Sources: Systematic literature review. A PubMed database research was performed. Relevant articles published in English were identified and scrutinized. Duplications of information and persistently unsolved uncertainties were excluded. Results: Cystic tumours of the pancreas should be differentiated from pancreatic pseudocysts. Cystic tumours could be classified into: cystic serous neoplasms (SCN), mucinous cystic neoplasms (MCN), intraductal papillary neoplasms (IPMN), solid pseudopapillary neoplasms (SPPN) and the rarer tumours cystic pancreatic endocrine neoplasms (PEN). Except for SCN, all these tumours should be regarded, at least, as potentially malignant but they may be frankly malignant. The age of the patient and site of the lesion may be helpful in the diagnosis. In particular, MCN is always encountered in females in their middle age and often in the body and tail of the pancreas. Many of these tumours are diagnosed incidentally. Pancreatitis and hyperamylasaemia should be interpretted with caution as IPMN may present as pancreatitis. CT is the primary diagnostic tool although MRI, EUS, PET, abdominal ultrasound and ERCP have all been utilised. Biochemical markers are of limited value in the diagnosis. Conclusions: Management decision depends primarily on the understanding of pathology and on how confident the preoperative diagnosis is. SCN may be observed. Partial pancreatectomy is the usual operation performed for most other tumours according to the location of the lesion which means that distal pancreatectomy is usually the operation performed for MCN. Total pancreatectomy for IPMN, enucleation and central pancreatectomy have all been described in the literature. Laparoscopy is more suitable for benign or low grade malignant tumours in the context of distal pancreatectomy. Spleen should be preserved unless splenectomy is

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The Indications For and Limitations of Tumor Enucleation

2018

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Enucleation of Pancreatic Cystadenomas

Abstract: It is safe and effective to perform enucleation for well-selected benign pancreatic cystadenomas even if the tumor size is as large as 6 cm, and the endocrine or exocrine function of the pancreas is maintained as much as possible.

Cited by 15 publications

References 17 publications

Long-term results of the surgical management of insulinoma patients with MEN1: a Groupe d'étude des Tumeurs Endocrines (GTE) retrospective study

Long-term results of the surgical management of insulinoma patients with MEN1: a Groupe d'étude des Tumeurs Endocrines (GTE) retrospective study

Cystic Tumours of the Pancreas: A Challenging Pathology, Diagnosis and Management

The Indications For and Limitations of Tumor Enucleation

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