Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Germany.
Department of Radiology, University Hospital of Heidelberg, Germany.
Surgery. 2022 Sep;172(3):968-974. doi: 10.1016/j.surg.2022.04.035. Epub 2022 Jun 6.
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.
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.
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%.
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.
胰腺部分切除术可保留胰腺实质，用于切除分支胰管内乳头状黏液性肿瘤。本研究旨在评估分支胰管内乳头状黏液性肿瘤患者行胰腺部分切除术的局部复发和长期随访后的功能结局。
分析了 2004 年至 2014 年间接受胰腺部分切除术治疗分支胰管内乳头状黏液性肿瘤的患者的临床特征、影像学和临床病理随访数据。采用 EORTC QLQ-C30 和 QLQ-PAN26 问卷评估生活质量。
74 例患者行胰腺部分切除术治疗低级别分支胰管内乳头状黏液性肿瘤 71 例，高级别分支胰管内乳头状黏液性肿瘤 3 例。66 例患者（89%）获得长期随访资料（中位随访时间：87 个月）。56 例行影像学检查的患者中，10 例（18%）出现肿瘤复发，包括 3 例（5%）在胰腺部分切除部位局部复发和 7 例（13%）在胰腺残端新出现的胰管内乳头状黏液性肿瘤。4 例（6%）患者再次手术。其中 2 例为胰管内乳头状黏液性肿瘤相关癌，其中 1 例位于胰腺部分切除部位。随访期间无胰管内乳头状黏液性肿瘤相关死亡病例，无新发胰岛素依赖型糖尿病。QLQ-C30 显示患者的总体健康状况为 66.0%，总体功能和症状评分为 81.0%和 22.8%。此外，QLQ-PAN26 显示总体症状评分为 26.5%。
胰腺部分切除术是一种保留器官的手术治疗方法，用于治疗低级别分支胰管内乳头状黏液性肿瘤，局部复发风险低，长期功能结局良好。然而，由于存在复发和潜在恶性的风险，任何类型的胰腺部分切除术后都必须进行终身随访。
