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  • Systematic Review and Meta-Analysis of Enucleation Versus Standardized Resection for Small Pancreatic Lesions

    Author(s)
    Chua, TC
    Yang, TX
    Gill, AJ
    Samra, JS
    Griffith University Author(s)
    Chua, Terence
    Year published
    2016
    Metadata
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    Abstract
    Background: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints ...
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    Background: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Results: Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105–114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297–330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2–3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0–2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1–0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02–0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93–98) and 84 % (range 79–90). Conclusions: Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.
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    Journal Title
    Annals of Surgical Oncology
    Volume
    23
    Issue
    2
    DOI
    https://doi.org/10.1245/s10434-015-4826-3
    Subject
    Oncology and carcinogenesis
    Publication URI
    http://hdl.handle.net/10072/388581
    Collection
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