Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms

Abstract

Background: Pancreatic enucleation is a tissue-sparing approach to pancreatic neoplasms and may result in better postoperative pancreatic function than standard pancreatic resection. The objective of this review was to compare the postoperative outcome after pancreatic enucleation versus standard resection.Methods: MEDLINE, Embase and the Cochrane Library were searched systematically until February 2015 to identify studies comparing the outcome of enucleation versus standard resection for pancreatic neoplasms. After critical appraisal, meta-analysis was performed and the findings were presented as odds ratios or weighted mean differences with corresponding 95 per cent c.i.Results: Twenty-two observational studies (1148 patients) were included. Duration of surgery (P < 0⋅001), blood loss (P < 0⋅001), length of hospital stay (P = 0⋅04), and postoperative endocrine (P < 0⋅001) and exocrine (P = 0⋅01) insufficiency were lower after enucleation than after standard resection. Mortality (P = 0⋅44), overall complications (P = 0⋅74), reoperation rate (P = 0⋅93) and delayed gastric emptying (P = 0⋅15) were not significantly different between the two approaches. The overall rate of postoperative pancreatic fistula (POPF) was higher after enucleation than after standard resection (P < 0⋅001). However, the raised POPF rate did not result in higher mortality or overall morbidity. Sensitivity analysis of high-volume studies (total of more than 20 enucleations and more than 4 per year) showed that, in specialized centres, enucleation can be performed with no increased risk of POPF (P = 0⋅12). Conclusion:Compared with standard resection, pancreatic enucleation can be performed effectively and with comparable safety in high-volume institutions. Enucleation should be considered instead of standard resection for selected pancreatic neoplasms.

A single institution’s 21-year experience with surgically resected pancreatic neuroendocrine tumors: an analysis of survival and prognostic factors

“…Firstly, the number of enucleations was lower (1/36 cases) and the greater incidence of POPF in enucleations in comparison with standard resections is well established. Secondly, we routinely administered octreotide and avoided the use of drains in the "pancreatic bed", as has been suggested in recent studies by Hüttnet et al (27). A recent meta-analysis reported a lower incidence of POPF in standard resections as compared to enucleations (OR = 2.09, p > 0.001; I2-16%).…”

Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma

“…Pancreatic resection has been reported to predispose new-onset DM and worsen glucose control after partial or total pancreatectomy and that the percentage of pancreatic parenchymal loss is roughly correlated with postoperative endocrine insufficiency, as evidenced by newly developed DM and worsening of glucose intolerance, [4,5,20] although there are contradictory reports. [28] In general, an RPV of 20% is Medicine considered the minimum requirement to avoid clinically relevant DM, provided that pancreas parenchyma is free of diffuse pathology after PD or DP.…”

“…[4] Although ideally as much pancreatic parenchyma should be preserved as possible to maintain good endocrine and exocrine pancreatic functions, sometimes only a small volume of pancreas is left after radical resection, and concerns regarding pancreatic insufficiency develop especially when a tumor is accompanied by parenchymal atrophy. [4][5][6] Most studies published so far on the functional and morphological evolution of remnant pancreas after resection had been conducted on patients with diverse disease entities that differ in the degrees of pancreatic duct dilatation, [5,[7][8][9][10][11] which can adversely affect pancreas function. [12] Furthermore, the method usually used to evaluate pancreas endocrine function was developed for diabetes mellitus (DM), [10] without consideration of the lower levels of blood glucose governed by glucagon, an important counter-regulatory hormone in glucose metabolism.…”

Pancreatic Cystic Neoplasms: Diagnosis, Management and Indications for Surgical Procedures. Part II

“…However, in the case of minor patients, taking into account the increased survival rate and the consequences of extensive surgery that considerably lower the quality of life, it is advisable to perform a minimum resection with tissue preservation, such as tumour enucleation whenever possible (64,65,66,67).…”