Abstract
Background
Pancreatic enucleation allows resection of branch-duct intraductal papillary mucinous
neoplasms with full parenchyma preservation. The aim of this study was to assess intraductal
papillary mucinous neoplasms recurrence and functional outcomes during long-term follow-up
after enucleation.
Methods
Patient characteristics, as well as radiologic and clinicopathologic follow-up data
of patients who underwent enucleation for branch-duct intraductal papillary mucinous
neoplasms between 2004 and 2014, were analyzed. Quality of life was assessed using
the EORTC QLQ-C30 and QLQ-PAN26 questionnaires.
Results
Seventy-four patients underwent enucleation for low-grade branch-duct intraductal
papillary mucinous neoplasms in 71 and high-grade branch-duct intraductal papillary
mucinous neoplasms in 3 patients. Long-term follow-up data were available for 66 patients
(89%; median follow-up: 87 months). Radiologic imaging (n = 56) showed intraductal papillary mucinous neoplasm recurrence in 10 patients (18%)
including local recurrence at the site of enucleation in 3 patients (5%) and new onset
intraductal papillary mucinous neoplasms manifestation in 7 patients (13%) at a distant
site in the pancreatic remnant. Four patients (6%) underwent reoperation. Two of these
patients had intraductal papillary mucinous neoplasm-associated carcinoma, one of
them at the enucleation site. During the follow-up period, no intraductal papillary
mucinous neoplasm-related deaths occurred and no new onsets of insulin-dependent diabetes
mellitus were observed. QLQ-C30 revealed a global health status of 66.0% and overall
functioning and symptom scores of 81.0% and 22.8%, respectively. Additionally, QLQ-PAN26
showed an overall symptom score of 26.5%.
Conclusion
Enucleation is an organ-preserving surgical treatment option for low-grade branch-duct
intraductal papillary mucinous neoplasms with low local recurrence risk and excellent
functional long-term outcome. However, postoperative life-long follow-up must be performed
as for any type of partial pancreatectomy for intraductal papillary mucinous neoplasms
due to the risk of recurrence and potential malignancy.
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References
- Intraductal neoplasms.in: 4 ed. AFIP Atlas of Tumor Pathology, Series 4: Tumors of the Pancreas Series. American Registry of Pathology, Washington, DC2007: 75-110
Correa-Gallego C, Ferrone CR, Thayer SP, et al. Incidental pancreatic cysts: do we really know what we are watching? Pancreatology. 10:144–150.
- Intraductal papillary mucinous neoplasms of the pancreas: an updated experience.Ann Surg. 2004; 239 (discussion 797–799): 788-797
- An illustrated consensus on the classification of pancreatic intraepithelial neoplasia and intraductal papillary mucinous neoplasms.Am J Surg Pathol. 2004; 28: 977-987
- Intraductal papillary-mucinous tumors of the pancreas.Arch Pathol Lab Med. 1995; 119: 197-198
- Intraductal Neoplasms of the Pancreas in WHO Classification of Tumor of the Digestive System.IARC, Lyon2010
- A revised classification system and recommendations from the Baltimore Consensus Meeting for Neoplastic Precursor Lesions in the Pancreas.Am J Surg Pathol. 2015; 39: 1730-1741
- Mucin-producing neoplasms of the pancreas: an analysis of distinguishing clinical and epidemiologic characteristics.Clin Gastroenterol Hepatol. 2010; 8: 213-219
- Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas.Pancreatology. 2017; 17: 738-753
- Prevalence of unsuspected pancreatic cysts on MDCT.AJR Am J Roentgenol. 2008; 191: 802-807
- Should all branch-duct intraductal papillary mucinous neoplasms be resected?.Am J Surg. 2015; 209: 478-482
- Validation of international consensus guidelines for the resection of branch duct-type intraductal papillary mucinous neoplasms.Br J Surg. 2014; 101: 686-692
- Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections.Langenbecks Arch Surg. 2011; 396: 1197-1203
- Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation?.HPB. 2011; 13: 126-131
- Risk of pancreatic fistula after enucleation of pancreatic tumours.Br J Surg. 2015; 102: 1258-1266
- Enucleation: a treatment alternative for branch duct intraductal papillary mucinous neoplasms.Surgery. Nov 21 2016; https://doi.org/10.1016/j.surg.2016.09.026
- Enucleation for benign or borderline tumors of the pancreas: comparing open and minimally invasive surgery.HPB (Oxford). 2021; 23: 921-926
- The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.Int J Surg. 2014; 12: 1495-1499
- The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376
- Updated EORTC QLQ-C30 general population norm data for Germany.Eur J Cancer. 2020; 137: 161-170
- Long-term quality of life after pancreatic surgery for intraductal papillary mucinous neoplasm.Eur Surg Res. 2021; 62: 80-87
- Improvement of surgical results for pancreatic cancer.Lancet Oncol. 2013; 14: e476-e485
- Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction After PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial.Ann Surg. 2016; 263: 440-449
- Accurate combined preoperative localization of insulinomas aid the choice for enucleation: a single institution experience over 25 years.Hepatogastroenterology. 2012; 59: 1282-1285
- Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms.Br J Surg. 2015; 102: 1026-1136
- Enucleation for benign or low-grade malignant lesions of the pancreas: single-center experience with 65 consecutive patients.Surgery. 2015; 158: 1203-1210
- Surgical management of insulinomas: short- and long-term outcomes after enucleations and pancreatic resections.Arch Surg. 2012; 147: 261-266
- Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis.Surg Endosc. 2016; 30: 2657-2665
- Short- and long-term outcomes after enucleation of pancreatic tumors: an evidence-based assessment.Pancreatology. 2016; 16: 1092-1098
- Postoperative outcomes of enucleation and standard resections in patients with a pancreatic neuroendocrine tumor.World J Surg. 2016; 40: 715-728
- Recurrence patterns after surgical resection of intraductal papillary mucinous neoplasm (IPMN) of the pancreas; a multicenter, retrospective study of 1074 IPMN patients by the Japan Pancreas Society.J Gastroenterol. 2020; 55: 86-99
- Parenchyma-sparing pancreatectomy for presumed noninvasive intraductal papillary mucinous neoplasms of the pancreas.Ann Surg. 2014; 260: 364-371
- New onset of diabetes and pancreatic exocrine insufficiency after pancreaticoduodenectomy for benign and malignant tumors: a systematic review and meta-analysis of long-term results.Ann Surg. 2018; 267: 259-270
- Enucleation of pancreatic neoplasms.Br J Surg. 2007; 94: 1254-1259
- Pancreatic enucleation patients share the same quality of life as the general population at long-term follow-up: a propensity-score matched analysis.Ann Surg. 2021; (Online ahead of print)https://doi.org/10.1097/SLA.0000000000004911
Article info
Publication history
Published online: June 06, 2022
Accepted:
April 20,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
