TY - JOUR
T1 - Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate
T2 - Resection or enucleation?
AU - Turrini, Olivier
AU - Schmidt, C. Max
AU - Pitt, Henry A.
AU - Guiramand, Jerome
AU - Aguilar-Saavedra, Juan R.
AU - Aboudi, Shadi
AU - Lillemoe, Keith D.
AU - Delpero, Jean Robert
PY - 2011/2
Y1 - 2011/2
N2 - Introduction: Side-branch intraductal papillary mucinous neoplasms (IPMN) of the pancreatic head/uncinate are an increasingly common indication for pancreaticoduodenectomy (PD). However, enucleation (EN) may be an alternative to PD in selected patients to improve outcomes and preserve pancreatic parenchyma. Aim: To determine peri-operative outcomes in patients with side-branch IPMN of the pancreatic head/uncinate undergoing EN or PD compared with a cohort of patients with pancreatic adenocarcinoma (PA) undergoing PD. Methods: Retrospective review of a prospectively collected, combined, academic institutional series from 2005 to 2008. Of 107 pancreatic head/uncinate IPMN, enucleation was performed in 7 (IPMN EN) and PD was performed in 100 (IPMN PD) with 17 of these radiographically amenable to EN (IPMN PDen). During the same time period, 281 patients underwent PD for PA (Control PD). Results: Operative time was shorter (p < 0.05) and blood loss (p < 0.05) was less in the IPMN EN group compared with all other groups. Peri-operative mortality and morbidity of all IPMN groups (IPMN EN, IPMN PDen) were similar to the Control PD group. Overall pancreatic fistulae rate in the IPMN EN group was higher than in the IPMN PDen and Control PD groups; however, the rate of grade C pancreatic fistulae was the same in all groups. Conclusions: Pancreaticoduodenectomy for side-branch IPMNs can be performed safely. Compared with PD, enucleation for IPMN has less blood loss, shorter operative time and similar morbidity, mortality, hospital length of stay (LOS) and readmission rate. Enucleation should be considered more frequently as an option for patients with unifocal side-branch IPMN.
AB - Introduction: Side-branch intraductal papillary mucinous neoplasms (IPMN) of the pancreatic head/uncinate are an increasingly common indication for pancreaticoduodenectomy (PD). However, enucleation (EN) may be an alternative to PD in selected patients to improve outcomes and preserve pancreatic parenchyma. Aim: To determine peri-operative outcomes in patients with side-branch IPMN of the pancreatic head/uncinate undergoing EN or PD compared with a cohort of patients with pancreatic adenocarcinoma (PA) undergoing PD. Methods: Retrospective review of a prospectively collected, combined, academic institutional series from 2005 to 2008. Of 107 pancreatic head/uncinate IPMN, enucleation was performed in 7 (IPMN EN) and PD was performed in 100 (IPMN PD) with 17 of these radiographically amenable to EN (IPMN PDen). During the same time period, 281 patients underwent PD for PA (Control PD). Results: Operative time was shorter (p < 0.05) and blood loss (p < 0.05) was less in the IPMN EN group compared with all other groups. Peri-operative mortality and morbidity of all IPMN groups (IPMN EN, IPMN PDen) were similar to the Control PD group. Overall pancreatic fistulae rate in the IPMN EN group was higher than in the IPMN PDen and Control PD groups; however, the rate of grade C pancreatic fistulae was the same in all groups. Conclusions: Pancreaticoduodenectomy for side-branch IPMNs can be performed safely. Compared with PD, enucleation for IPMN has less blood loss, shorter operative time and similar morbidity, mortality, hospital length of stay (LOS) and readmission rate. Enucleation should be considered more frequently as an option for patients with unifocal side-branch IPMN.
KW - cystic tumours
KW - outcomes
KW - resection
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UR - http://www.scopus.com/inward/citedby.url?scp=78751652187&partnerID=8YFLogxK
U2 - 10.1111/j.1477-2574.2010.00256.x
DO - 10.1111/j.1477-2574.2010.00256.x
M3 - Article
C2 - 21241430
AN - SCOPUS:78751652187
SN - 1365-182X
VL - 13
SP - 126
EP - 131
JO - HPB
JF - HPB
IS - 2
ER -