Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
Langenbecks Arch Surg. 2011 Dec;396(8):1197-203. doi: 10.1007/s00423-011-0801-z. Epub 2011 May 8.
Pancreatic surgery is a technically challenging intervention with high demands for preoperative diagnostics and perioperative management. A perioperative mortality rate below 5% is achieved in high-volume centers due to the high level of standardization in surgical procedures and perioperative care. Besides standard resections, certain indications may require individualized surgical concepts such as tumor enucleations. The aim of the study was to evaluate the indications, technique, and outcome of this limited local approach compared to major resections.
Data from patients undergoing pancreatic surgery were prospectively recorded. All patients with tumor enucleations were compared with classical resections (pancreaticoduodenectomy or left resection) in a matched-pair analysis (1:2). Tumor type, localization, operative parameters, complications, and outcome were evaluated.
Fifty-three patients underwent pancreatic tumor enucleation between October 2001 and December 2009. Indications included cystic lesions, IPMNs, and neuroendocrine pancreatic tumors. Enucleations were associated with shorter operation time, less blood loss as well as shorter ICU and hospital stay compared to pancreaticoduodenectomy and left resections. The overall surgical morbidity of enucleations was 28.3% without major complications. Leading clinical problems were ISGPF type A fistulas (20.8%) requiring prolonged primary drainage. No surgical revisions were necessary, and no deaths occurred.
Pancreatic tumor enucleations can be carried out with good results and no mortality. Decisions regarding enucleations are highly individual compared to standard resections, underlining the importance of treatment in experienced high-volume institutions. Enucleations should be carried out whenever possible and oncologically feasible to prevent the typical complications of major pancreatic resection.
胰腺手术是一项技术要求很高的干预措施，对术前诊断和围手术期管理要求很高。由于手术程序和围手术期护理的高度标准化，高容量中心的围手术期死亡率低于 5%。除了标准切除外，某些适应症可能需要个体化的手术概念，例如肿瘤剜除术。本研究旨在评估与主要切除术相比，这种有限局部方法的适应症、技术和结果。
前瞻性记录接受胰腺手术的患者数据。所有接受肿瘤剜除术的患者均与经典切除术（胰十二指肠切除术或左切除术）进行配对分析（1:2）。评估肿瘤类型、定位、手术参数、并发症和结果。
2001 年 10 月至 2009 年 12 月期间，53 例患者接受胰腺肿瘤剜除术。适应症包括囊性病变、IPMNs 和神经内分泌胰腺肿瘤。与胰十二指肠切除术和左切除术相比，剜除术具有较短的手术时间、较少的出血量以及较短的 ICU 和住院时间。剜除术的总体手术发病率为 28.3%，无重大并发症。主要临床问题是 ISGPF 型 A 瘘（20.8%），需要延长初次引流。无需手术修正，也无死亡病例发生。
胰腺肿瘤剜除术可以取得良好的效果且无死亡率。与标准切除术相比，剜除术的决策具有高度的个体性，强调了在经验丰富的高容量机构中进行治疗的重要性。只要有可能且在肿瘤学上可行，应尽可能进行剜除术，以防止主要胰腺切除术的典型并发症。
