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Lookup NU author(s): Professor Sanjay PandanaboyanaORCiD
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© 2019 International Hepato-Pancreato-Biliary Association Inc.Background: The role of enucleation (EN) for branch duct intraductal papillary mucinous neoplasms (BD-IPMN) is poorly defined. This systematic review aims to review EN for BD-IPMN and compare it with pancreatic resection (pancreaticoduodenectomy, distal pancreatectomy and central pancreatectomy). Methods: A systematic review of published literature was performed using PRISMA guidelines, and included a search of PubMed, MEDLINE and SCOPUS databases. Results: Sixteen studies were included in the final analysis comprising 991 patients with 293 EN patients and 698 resected patients. EN was most often performed for low grade (77%, 151/197) BD-IPMN's (99%, 251/253) of the pancreatic head (64%, 106/165), with a pooled mean diameter of 21 mm (SD 28 mm). EN was a shorter procedure (MD −115.8 min, CI −142.2 to −89.5 min, P=<0.001) with a lower rate of post-pancreatectomy haemorrhage (EN 1% 2/144, Resection 5% 10/186, RR 0.32, CI 0.11 to 0.94, P = 0.043) and postoperative exocrine and endocrine insufficiency (P = <0.001 and P = 0.003 respectively) than resection. Conclusion: EN for BD-IPMN's appears to be a reasonable alternative to resection in low risk BD-IPMN's, allowing preservation of exocrine and endocrine function with comparable reoperation and recurrence rates to resection. However, surveillance was indicated in these low risk patients based on current published guidelines.
Author(s): Ratnayake CB, Biela C, Windsor JA, Pandanaboyana S
Publication type: Review
Publication status: Published
Journal: HPB
Year: 2019
Volume: 21
Issue: 12
Pages: 1593-1602
Print publication date: 01/12/2019
Online publication date: 29/05/2019
Acceptance date: 17/04/2019
ISSN (print): 1365-182X
ISSN (electronic): 1477-2574
Publisher: Elsevier B.V.
URL: https://doi.org/10.1016/j.hpb.2019.04.015
DOI: 10.1016/j.hpb.2019.04.015
PubMed id: 31153837
