Division of General Surgery, Hepato-pancreato-biliary Unit, Department of Medicine and Surgery, Parma University Hospital, Via Linati 6, 43121, Parma, Italy.
Department of Surgery, Poliambulanza Foundation, Brescia, Italy.
Surg Endosc. 2019 Oct;33(10):3192-3199. doi: 10.1007/s00464-019-06967-9. Epub 2019 Jul 30.
Pancreatic enucleation (pEN) as parenchyma-sparing procedure for small pancreatic neoplasms is quickly becoming the most common surgical option in such setting. Nowadays, pEN is frequently carried out through a minimally invasive approach either laparoscopic or robotic. Its impact on overall perioperative complications and pancreatic fistula (POPF) is still under evaluation. The scope of our systematic review is to assess pEN's perioperative outcomes and to evaluate the effect of the minimally invasive techniques over POPF and other surgical complications.
We performed a systematic literature search (time-frame January 1999-September 2018), considering exclusively those studies which included at least 5 cases of either open or minimally invasive pEN. Data regarding postoperative outcome and POPF were extracted and analyzed. We defined postoperative morbidities by the Clavien-Dindo classification while POPF according to the International Study Group of Pancreatic Fistula (ISGPF) definition.
Sixty-three studies met the criteria selected, accounting for a study population of 2485 patients. 27.7% had a minimally invasive pEN. The overall postoperative morbidity rate was 46.1% with 11.9% rated as severe (Clavien-Dindo ≥ 3). Mortality rate was 0.69%. The minimally invasive approach to pEN led to a statistically significant reduction of both the overall POPF rate (28.7% vs. 45.9%, p < 0.001), and clinically significant B-C POPF (p < 0.027). The postoperative overall morbidity rate was clearly in favor of the minimally invasive approach (27.6% vs. 55.2%, p < 0.001).
Our review confirms that pEN is a safe and feasible technique for the treatment of small benign or low-grade pancreatic neoplasms and it can be implemented with an acceptable morbidity rate along with low mortality. The minimally invasive approach is gaining widespread acceptance due to its supposed non-inferiority compared with the traditional open approach. In our review, it showed to be even better in terms of POPF incidence rate and short-term postoperative outcome. Still, such data need to be corroborated by randomized clinical trials.
胰腺部分切除术（pEN）作为一种保留胰腺实质的手术方法，用于治疗小的胰腺肿瘤，目前已迅速成为此类情况下最常见的手术选择。如今，pEN 通常通过腹腔镜或机器人辅助的微创方法进行。它对围手术期总体并发症和胰腺瘘（POPF）的影响仍在评估中。我们的系统评价范围是评估 pEN 的围手术期结果，并评估微创技术对 POPF 和其他手术并发症的影响。
我们进行了系统的文献检索（时间范围为 1999 年 1 月至 2018 年 9 月），仅考虑了那些至少包括 5 例开放或微创 pEN 病例的研究。提取并分析了术后结果和 POPF 数据。我们根据 Clavien-Dindo 分类定义术后并发症，根据国际胰腺瘘研究组（ISGPF）的定义定义 POPF。
63 项研究符合所选标准，共纳入 2485 例患者。27.7%的患者行微创 pEN。总的术后发病率为 46.1%，11.9%为严重（Clavien-Dindo≥3）。死亡率为 0.69%。微创 pEN 显著降低了总体 POPF 发生率（28.7%比 45.9%，p<0.001）和临床显著 B-C POPF（p<0.027）。微创方法的术后总体发病率明显更有利（27.6%比 55.2%，p<0.001）。
我们的综述证实，pEN 是治疗小的良性或低级别胰腺肿瘤的一种安全且可行的技术，它可以以可接受的发病率和低死亡率实施。微创方法由于与传统的开放方法相比具有非劣效性，因此得到了广泛的认可。在我们的综述中，它在 POPF 发生率和短期术后结果方面表现得更好。然而，此类数据仍需要通过随机临床试验来证实。
