Heeger Kristin, Falconi Massimo, Partelli Stefano, Waldmann Jens, Crippa Stefano, Fendrich Volker, Bartsch Detlef K
Department of Surgery, Philipps-University, Baldingerstraße, D-35043, Marburg, Germany,
Langenbecks Arch Surg. 2014 Mar;399(3):315-21. doi: 10.1007/s00423-014-1171-0. Epub 2014 Feb 14.
Only small, potentially benign pancreatic tumors located ≥3 mm distant from the main pancreatic duct (MPD) are considered good candidates for enucleation. This study evaluates the outcome of enucleations with regard to their distance to the MPD.
Clinical characteristics, complications, and outcomes of prospectively documented patients with small (≤30 mm), potentially benign pancreatic tumors, who underwent enucleation, were retrospectively analyzed. Patients were divided in two groups, either deep enucleation (DE, distance ≤3 mm) or standard enucleation (SE, distance >3 mm), as determined by intraoperative ultrasonography (IOUS).
Sixty patients underwent DE (n = 30) or SE (n = 30) with IOUS. Both groups did not differ regarding age, tumor size, pathology, and operating time. Complications occurred in 24/30 (80 %) patients of the DE group compared to 15/30 (50 %) patients after SE (P = 0.029). Mortality was nil. The most frequent complication was pancreatic fistula (POPF) occurring in 22/30 (73.3 %) patients after DE and 9/30 (30 %) patients undergoing SE (P = 0.002). Especially, the rate of clinically significant POPF types B and C was higher after DE (21 of 30 patients) compared to SE (7 of 30 patients, P = 0.0006). Univariate and multivariate analyses revealed DE as the only significant factor that negatively influenced the occurrence of POPF. Postoperative hospital stay tended to be longer after DE (15 vs. 11.5 days, P = 0.050). All but two patients with metastatic gastrinoma and two patients, who died of unrelated causes, showed no evidence of disease after a median follow-up of 24 (3-235) months.
Deep enucleation of small, potentially benign pancreatic tumors should be considered with caution given the high rate of clinically relevant POPF.
仅距离主胰管（MPD）≥3mm的小的、可能为良性的胰腺肿瘤被认为是剜除术的良好候选对象。本研究评估了剜除术的结果与肿瘤距MPD距离的关系。
对前瞻性记录的接受剜除术的小（≤30mm）的、可能为良性的胰腺肿瘤患者的临床特征、并发症及结局进行回顾性分析。根据术中超声检查（IOUS）将患者分为两组，即深部剜除术（DE，距离≤3mm）或标准剜除术（SE，距离>3mm）。
60例患者接受了IOUS引导下的DE（n = 30）或SE（n = 30）。两组在年龄、肿瘤大小、病理及手术时间方面无差异。DE组24/30（80%）的患者发生了并发症，而SE组为15/30（50%）（P = 0.029）。无死亡病例。最常见的并发症是胰瘘（POPF），DE组22/30（73.3%）的患者发生了POPF，而接受SE的患者为9/30（30%）（P = 0.002）。特别是，DE后B型和C型具有临床意义的POPF发生率（30例患者中的21例）高于SE（30例患者中的7例，P = 0.0006）。单因素和多因素分析显示，DE是唯一对POPF发生有负面影响的显著因素。DE后的术后住院时间往往更长（15天对11.5天，P = 0.
