Faitot Francois, Gaujoux Sébastien, Barbier Louise, Novaes Marleny, Dokmak Safi, Aussilhou Béatrice, Couvelard Anne, Rebours Vinciane, Ruszniewski Philippe, Belghiti Jacques, Sauvanet Alain
AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France.
AP-HP, Department of Hepato-Pancreato-Biliary Surgery, Hôpital Beaujon, DHU UNITY, Clichy, France; Université Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale, Centre de Recherche Biomédicale Bichat Beaujon, (CRB3)/INSERM U773, Clichy, France.
Surgery. 2015 Jul;158(1):201-10. doi: 10.1016/j.surg.2015.03.023. Epub 2015 May 5.
Parenchyma-sparing pancreatectomies, especially enucleations, could avoid disappointing functional results associated with standard resections for benign/low-grade pancreatic neoplasms. This study aimed to assess short- and long-term outcomes in a large, single-center series of enucleations.
All 126 patients who underwent enucleation for benign/low-grade neoplasms between 1996 and 2011 were included retrospectively.
Lesions were mainly incidentally diagnosed (71%), most often located in the head (46%), and with a median size of 20 mm. Enucleations were mainly performed for branch-duct intraductal papillary mucinous neoplasm (30%), nonfunctioning pancreatic neuroendocrine tumors (29%), and mucinous cystadenoma (21%). Overall mortality was 0.8% and morbidity 63%, mainly owing to pancreatic fistula (57%). Most were significant clinically, that is, grade B or C (41%), but managed conservatively (85%). Reoperation rate was 3%, mainly owing to hemorrhage. Postoperative de novo diabetes was 0.8%, and exocrine insufficiency never observed. The 1-, 3-, and 5-year recurrence-free survival were 100%, 98%, and 93%, respectively.
Enucleation is associated with substantial morbidity, especially pancreatic fistula. Enucleations as an alternative to standard resection are best indicated for small, benign, and low-grade lesions located far from the main pancreatic duct. Enucleations should be proposed to young and fit patients able to tolerate postoperative morbidity and who could benefit from the excellent long-term results.
保留实质的胰腺切除术，尤其是摘除术，可避免因对良性/低级别胰腺肿瘤进行标准切除术而导致的令人失望的功能结果。本研究旨在评估一个大型单中心摘除术系列的短期和长期结果。
回顾性纳入1996年至2011年间接受良性/低级别肿瘤摘除术的所有126例患者。
病变主要为偶然诊断（71%），最常见于胰头（46%），中位大小为20毫米。摘除术主要针对分支导管内乳头状黏液性肿瘤（30%）、无功能性胰腺神经内分泌肿瘤（29%）和黏液性囊腺瘤（21%）进行。总体死亡率为0.8%，发病率为63%，主要原因是胰瘘（57%）。大多数在临床上较为严重，即B级或C级（41%），但通过保守治疗（85%）。再次手术率为3%，主要原因是出血。术后新发糖尿病为0.8%，未观察到外分泌功能不全。1年、3年和5年无复发生存率分别为100%、98%和93%。
摘除术与较高的发病率相关，尤其是胰瘘。作为标准切除术的替代方法，摘除术最适合用于远离主胰管的小的、良性的和低级别病变。对于能够耐受术后发病率且能从优异的长期结果中获益的年轻且健康的患者，应考虑进行摘除术。
