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CLC number: R735.9

On-line Access: 2017-10-05

Received: 2017-01-03

Revision Accepted: 2017-02-12

Crosschecked: 2017-09-15

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Bin Xu


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Journal of Zhejiang University SCIENCE B 2017 Vol.18 No.10 P.906-916


Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections

Author(s):  Wen-jie Lu, Hao-lei Cai, Ma-dong Ye, Yu-lian Wu, Bin Xu

Affiliation(s):  Department of Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China

Corresponding email(s):   xb0426@163.com

Key Words:  Enucleation, Pancreatic fistula, Pancreaticoduodenectomy, Central pancreatectomy

Wen-jie Lu, Hao-lei Cai, Ma-dong Ye, Yu-lian Wu, Bin Xu. Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections[J]. Journal of Zhejiang University Science B, 2017, 18(10): 906-916.

@article{title="Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections",
author="Wen-jie Lu, Hao-lei Cai, Ma-dong Ye, Yu-lian Wu, Bin Xu",
journal="Journal of Zhejiang University Science B",
publisher="Zhejiang University Press & Springer",

%0 Journal Article
%T Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections
%A Wen-jie Lu
%A Hao-lei Cai
%A Ma-dong Ye
%A Yu-lian Wu
%A Bin Xu
%J Journal of Zhejiang University SCIENCE B
%V 18
%N 10
%P 906-916
%@ 1673-1581
%D 2017
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1600597

T1 - Enucleation of non-invasive tumors in the proximal pancreas: indications and outcomes compared with standard resections
A1 - Wen-jie Lu
A1 - Hao-lei Cai
A1 - Ma-dong Ye
A1 - Yu-lian Wu
A1 - Bin Xu
J0 - Journal of Zhejiang University Science B
VL - 18
IS - 10
SP - 906
EP - 916
%@ 1673-1581
Y1 - 2017
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1600597

Objective: The aim of this study was to evaluate the safety and efficiency of enucleation (EU) for proximal pancreatic non-invasive neoplasms. Methods: Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included. Different operations and outcomes were analyzed. Results: A total of 123 patients were enrolled. Forty patients (32.5%) underwent EU including 18 patients who had tumors close to the main pancreatic duct (MPD). Sixty-one patients (49.6%) had pancreaticoduodenectomy (PD) performed and 22 (17.9%) underwent central pancreatectomy (CP). Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors. Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group. PD was associated with the greatest complication rate (55.7%), followed by EU (50%) and CP (40.9%), though the pancreatic fistula rate after EU was the highest (50%), especially in patients with tumors larger than 3 cm and tumors close to the MPD. EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function. Conclusions: EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.


创新点:以目前为止最大样本量的近端胰腺非侵袭性肿瘤的剜除手术的数据分析,证实了剜除手术在这类患者中的安全性和有效性,即使肿瘤直径>3 cm或临近主胰管肿瘤。并且首次报道和证实了在这些患者剜除手术中发生主胰管损伤,进行主胰管修补与支架置入是安全有效的。分析了同期进行不同手术方式患者的肿瘤资料,阐明了肿瘤大小影响手术策略的制定。


Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article


[1]Atema, J.J., Jilesen, A.P., Busch, O.R., et al., 2015. Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions. HPB, 17(1):38-45.

[2]Bassi, C., Dervenis, C., Butturini, G., et al., 2005. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 138(1):8-13.

[3]Beger, H.G., Poch, B., Vasilescu, C., 2014. Benign cystic neoplasm and endocrine tumours of the pancreas—when and how to operate—an overview. Int. J. Surg., 12(6):606-614.

[4]Brient, C., Regenet, N., Sulpice, L., et al., 2012. Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J. Gastrointest. Surg., 16(10):1883-1887.

[5]Butte, J.M., Brennan, M.F., Gönen, M., et al., 2011. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J. Gastrointest. Surg., 15(2):350-357.

[6]Casadei, R., Ricci, C., Rega, D., et al., 2010. Pancreatic endocrine tumors less than 4 cm in diameter: resect or enucleate? A single-center experience. Pancreas, 39(6):825-828.

[7]Cauley, C.E., Pitt, H.A., Ziegler, K.M., et al., 2012. Pancreatic enucleation: improved outcomes compared to resection. J. Gastrointest. Surg., 16(7):1347-1353.

[8]Crippa, S., Bassi, C., Salvia, R., et al., 2007. Enucleation of pancreatic neoplasms. Br. J. Surg., 94(10):1254-1259.

[9]Crippa, S., Boninsegna, L., Partelli, S., et al., 2010. Parenchyma-sparing resections for pancreatic neoplasms. J. Hepatobiliary Pancreat. Sci., 17(6):782-787.

[10]Dong, X., Gao, S.L., Xie, Q.P., et al., 2008. In situ high-volume modified continuous closed and/or open lavage for infected necrotizing pancreatitis. Pancreas, 36(1):44-49.

[11]Falconi, M., Zerbi, A., Crippa, S., et al., 2010. Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann. Surg. Oncol., 17(6):1621-1627.

[12]Ferrone, C.R., Tang, L.H., Tomlinson, J., et al., 2007. Determining prognosis in patients with pancreatic endocrine neoplasms: can the WHO classification system be simplified? J. Clin. Oncol., 25(35):5609-5615.

[13]Ge, C., Luo, X., Chen, X., et al., 2010. Enucleation of pancreatic cystadenomas. J. Gastrointest. Surg., 14(1):141-147.

[14]Ghaneh, P., Neoptolemos, J.P., 1999. Exocrine pancreatic function following pancreatectomy. Ann. N. Y. Acad. Sci., 880:308-318.

[15]Goasguen, N., Bourrier, A., Ponsot, P., et al., 2009. Endoscopic management of pancreatic fistula after distal pancreatectomy and enucleation. Am. J. Surg., 197(6):715-720.

[16]Grobmyer, S.R., Pieracci, F.M., Allen, P.J., et al., 2007. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J. Am. Coll. Surg., 204(3):356-364.

[17]Hackert, T., Hinz, U., Fritz, S., et al., 2011. Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbeck’s Arch. Surg., 396(8):1197-1203.

[18]Heeger, K., Falconi, M., Partelli, S., et al., 2014. Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbeck’s Arch. Surg., 399(3):315-321.

[19]Ho, V., Heslin, M.J., 2003. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann. Surg., 237(4):509-514.

[20]Howard, J.M., Hess, W., 2002. History of the Pancreas: Mystery of a Hidden Organ. Kluwer Academic/Plenum Publisher, New York.

[21]Inchauste, S.M., Lanier, B.J., Libutti, S.K., et al., 2012. Rate of clinically significant postoperative pancreatic fistula in pancreatic neuroendocrine tumors. World J. Surg., 36(7):1517-1526.

[22]Kiely, J.M., Nakeeb, A., Komorowski, R.A., et al., 2003. Cystic pancreatic neoplasms: enucleate or resect? J. Gastrointest. Surg., 7(7):890-897.

[23]Kulke, M.H., Benson, A.B.3rd, Bergsland, E., et al., 2012. Neuroendocrine tumors. J. Natl. Compr. Canc. Netw., 10(6):724-764.

[24]le Borgne, J., de Calan, L., Partensky, C., 1999. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann. Surg., 230(2):152-161.

[25]Lu, W.J., Xu, B., Gao, S.L., et al., 2012. Enucleation of benign or borderline pancreatic head tumors adjacent to the common pancreatic duct. Pancreas, 41(2):336-337.

[26]Madan, A.K., Weldon, C.B., Long, W.P., et al., 2004. Solid and papillary epithelial neoplasm of the pancreas. J. Surg. Oncol., 85(4):193-198.

[27]Norton, J.A., 2006. Surgery for primary pancreatic neuroendocrine tumors. J. Gastrointest. Surg., 10(3):327-331.

[28]Papavramidis, T., Papavramidis, S., 2005. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J. Am. Coll. Surg., 200(6):965-972.

[29]Pitt, S.C., Pitt, H.A., Baker, M.S., et al., 2009. Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J. Gastrointest. Surg., 13(9):1692-1698.

[30]Ramage, J.K., Davies, A.H., Ardill, J., et al., 2005. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut, 54:iv1-iv16.

[31]Reid-Lombardo, K.M., Ramos-de la Medin, A., Thomsen, K., et al., 2007. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J. Gastrointest. Surg., 11(12):1704-1711.

[32]Schmidt, C.M., White, P.B., Waters, J.A., et al., 2007. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann. Surg., 246(4):644-654.

[33]Sciaudone, G., Perniceni, T., Lévy, P., et al., 2000. Enucleation of intraductal papillary-mucinous tumor of the head of the pancreas. Report of 2 cases. Gastroenterol. Clin. Biol., 24(1):121-124 (in French).

[34]Talamini, M.A., Moesinger, R., Yeo, C.J., et al., 1998. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann. Surg., 227(6):896-903.

[35]Tran, T.C., van Lanschot, J.J., Bruno, M.J., et al., 2009. Functional changes after pancreatoduodenectomy: diagnosis and treatment. Pancreatology, 9(6):729-737.

[36]Turrini, O., Schmidt, C.M., Pitt, H.A., et al., 2011. Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? HPB, 13(2):126-131.

[37]Valsangkar, N.P., Morales-Oyarvide, V., Thayer, S.P., et al., 2012. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery, 152(3 Suppl.):S4-S12.

[38]Wente, M.N., Veit, J.A., Bassi, C., et al., 2007a. Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 142(1):20-25.

[39]Wente, M.N., Bassi, C., Dervenis, C., et al., 2007b. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 142(5):761-768.

[40]Yan, J.F., Kuang, T.T., Ji, D.Y., et al., 2015. Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 16(7):573-579.

[41]Zhang, T., Xu, J., Wang, T., et al., 2013. Enucleation of pancreatic lesions: indications, outcomes, and risk factors for clinical pancreatic fistula. J. Gastrointest. Surg., 17(12):2099-2104.

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