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Enucleation for branch duct intraductal papillary mucinous neoplasms: a systematic review and meta-analysis

Lookup NU author(s): 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.

Publication metadata

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.


DOI: 10.1016/j.hpb.2019.04.015

PubMed id: 31153837