Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions

Terence C. Chua, Timothy X. Yang, Anthony J. Gill, Jaswinder S. Samra

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Background: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Results: Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105–114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297–330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2–3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0–2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1–0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02–0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93–98) and 84 % (range 79–90). Conclusions: Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.

LanguageEnglish
Pages592-599
Number of pages8
JournalAnnals of Surgical Oncology
Volume23
Issue number2
DOIs
Publication statusPublished - 1 Feb 2016

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Meta-Analysis
Confidence Intervals
Odds Ratio
Pancreatic Fistula
Survival
Literature
Neuroendocrine Tumors
Mortality
PubMed
MEDLINE
Safety
Recurrence

Cite this

Chua, Terence C. ; Yang, Timothy X. ; Gill, Anthony J. ; Samra, Jaswinder S. / Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 2. pp. 592-599.
@article{b7420f05a6f248b99cbd4503ee14398b,
title = "Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions",
abstract = "Background: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Results: Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 {\%} confidence interval (CI) 105–114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 {\%} CI 297–330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 {\%} CI 1.2–3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 {\%} CI 1.0–2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 {\%} CI 0.1–0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 {\%} CI 0.02–0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 {\%} (range 93–98) and 84 {\%} (range 79–90). Conclusions: Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.",
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Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions. / Chua, Terence C.; Yang, Timothy X.; Gill, Anthony J.; Samra, Jaswinder S.

In: Annals of Surgical Oncology, Vol. 23, No. 2, 01.02.2016, p. 592-599.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Systematic review and meta-analysis of enucleation versus standardized resection for small pancreatic lesions

AU - Chua, Terence C.

AU - Yang, Timothy X.

AU - Gill, Anthony J.

AU - Samra, Jaswinder S.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Results: Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105–114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297–330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2–3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0–2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1–0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02–0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93–98) and 84 % (range 79–90). Conclusions: Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.

AB - Background: The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation. Methods: PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes. Results: Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105–114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297–330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2–3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0–2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1–0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02–0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93–98) and 84 % (range 79–90). Conclusions: Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.

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M3 - Review article

VL - 23

SP - 592

EP - 599

JO - Annals of Surgical Oncology

T2 - Annals of Surgical Oncology

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