Parenchyma-sparing, local pancreatic head resection for premalignant and low-malignant neoplasms – A systematic review and meta-analysis - 06/12/18
, Benjamin Mayer b, Bertram Poch cAbstract |
Background |
Parenchyma-sparing, local pancreatic head resection, but not pancreaticoduodenectomy (PD) preserves tissue and maintains the pancreatic metabolic functions.
Methods |
PubMed/Medline, Embase, and Cochrane library collections were systematically searched. Twenty-six cohort studies with 523 cumulative patients, who underwent duodenum-sparing pancreatic head resection (DPPHR), were retrieved. The meta-analysis was based on 14 controlled studies.
Results |
In total, 338 patients suffered cystic neoplasms and 59 PNETs, IPMN-174, MCN-43 and SPN-23 patients. Eighty-one patients (15.5%) histo-pathologically displayed a low-malignant tumor, of which 27 were carcinoma in-situ. Tumor recurrence was observed after a mean follow-up of 47.1 months in 11 patients. In-hospital and late mortality after DPPHR was 0.6% and 1.7%, respectively.
The meta-analysis was based on 318 DPPHR compared to 404 PD patients. DPPHR was performed for premalignant neoplasm and PNET in 164 and 46 patients, and PD in 181 and 46 patients, respectively. Events of recurrence displayed no statistically significant difference between the DPPHR and PD groups.
Conclusion |
DPPHR is associated with oncologically complete tumor resection for patients suffering premalignant IPMN, MCN, or SPN and for low-risk cancer.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Pancreatic cystic neoplasms and neuroendocrine tumors have high rates of malignant transformation. |
• | Local pancreatic head resection, but not the Whipple is associated with low surgery-related morbidity and maintenance of pancreatic functions. |
• | Parenchyma-sparing pancreatic head resection is associated with a low risk of recurrences as it is after Whipple resection. |
Keywords : Parenchyma-sparing pancreatic head resection, Duodenum-sparing pancreatic head resection, Total pancreatic head resection with segmental duodenal resection, Premalignant cystic neoplasm, Benign pancreatic tumor
Plan
Vol 216 - N° 6
P. 1182-1191 - décembre 2018 Retour au numéro
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