Francois Faitot1, Sébastien Gaujoux2, Louise Barbier3, Marleny Novaes1, Safi Dokmak1, Béatrice Aussilhou1, Anne Couvelard4, Vinciane Rebours5, Philippe Ruszniewski5, Jacques Belghiti3, Alain Sauvanet6. 1. AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France. 2. AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France. 3. AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France. 4. AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France; AP-HP, Department of Pathology, Hôpital Beaujon, DHU UNITY, Clichy, France. 5. Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France; AP-HP, Department of Gastroenterology, Hôpital Beaujon, DHU UNITY, Clichy, France. 6. AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France. Electronic address: alain.sauvanet@bjn.aphp.fr.
Abstract
BACKGROUND: Parenchyma-sparing pancreatectomies, especially enucleations, could avoid disappointing functional results associated with standard resections for benign/low-grade pancreatic neoplasms. This study aimed to assess short- and long-term outcomes in a large, single-center series of enucleations. METHODS: All 126 patients who underwent enucleation for benign/low-grade neoplasms between 1996 and 2011 were included retrospectively. RESULTS: Lesions were mainly incidentally diagnosed (71%), most often located in the head (46%), and with a median size of 20 mm. Enucleations were mainly performed for branch-duct intraductal papillary mucinous neoplasm (30%), nonfunctioning pancreatic neuroendocrine tumors (29%), and mucinous cystadenoma (21%). Overall mortality was 0.8% and morbidity 63%, mainly owing to pancreatic fistula (57%). Most were significant clinically, that is, grade B or C (41%), but managed conservatively (85%). Reoperation rate was 3%, mainly owing to hemorrhage. Postoperative de novo diabetes was 0.8%, and exocrine insufficiency never observed. The 1-, 3-, and 5-year recurrence-free survival were 100%, 98%, and 93%, respectively. CONCLUSION: Enucleation is associated with substantial morbidity, especially pancreatic fistula. Enucleations as an alternative to standard resection are best indicated for small, benign, and low-grade lesions located far from the main pancreatic duct. Enucleations should be proposed to young and fit patients able to tolerate postoperative morbidity and who could benefit from the excellent long-term results.
BACKGROUND: Parenchyma-sparing pancreatectomies, especially enucleations, could avoid disappointing functional results associated with standard resections for benign/low-grade pancreatic neoplasms. This study aimed to assess short- and long-term outcomes in a large, single-center series of enucleations. METHODS: All 126 patients who underwent enucleation for benign/low-grade neoplasms between 1996 and 2011 were included retrospectively. RESULTS: Lesions were mainly incidentally diagnosed (71%), most often located in the head (46%), and with a median size of 20 mm. Enucleations were mainly performed for branch-duct intraductal papillary mucinous neoplasm (30%), nonfunctioning pancreatic neuroendocrine tumors (29%), and mucinous cystadenoma (21%). Overall mortality was 0.8% and morbidity 63%, mainly owing to pancreatic fistula (57%). Most were significant clinically, that is, grade B or C (41%), but managed conservatively (85%). Reoperation rate was 3%, mainly owing to hemorrhage. Postoperative de novo diabetes was 0.8%, and exocrine insufficiency never observed. The 1-, 3-, and 5-year recurrence-free survival were 100%, 98%, and 93%, respectively. CONCLUSION: Enucleation is associated with substantial morbidity, especially pancreatic fistula. Enucleations as an alternative to standard resection are best indicated for small, benign, and low-grade lesions located far from the main pancreatic duct. Enucleations should be proposed to young and fit patients able to tolerate postoperative morbidity and who could benefit from the excellent long-term results.
Authors: Dan Petru Constantinescu; Mihaela Ioana Constantinescu; Razvan Alexandru Ciocan; Stefan Chiorescu; Miana Gabriela Pop; Daniela Simona Pintea; Valentin Muntean Journal: Int J Surg Case Rep Date: 2019-09-24