Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: Resection or enucleation?

Olivier Turrini, C. Schmidt, Henry A. Pitt, Jerome Guiramand, Juan R. Aguilar-Saavedra, Shadi Aboudi, Keith D. Lillemoe, Jean Robert Delpero

Research output: Contribution to journalArticle

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Abstract

Introduction: Side-branch intraductal papillary mucinous neoplasms (IPMN) of the pancreatic head/uncinate are an increasingly common indication for pancreaticoduodenectomy (PD). However, enucleation (EN) may be an alternative to PD in selected patients to improve outcomes and preserve pancreatic parenchyma. Aim: To determine peri-operative outcomes in patients with side-branch IPMN of the pancreatic head/uncinate undergoing EN or PD compared with a cohort of patients with pancreatic adenocarcinoma (PA) undergoing PD. Methods: Retrospective review of a prospectively collected, combined, academic institutional series from 2005 to 2008. Of 107 pancreatic head/uncinate IPMN, enucleation was performed in 7 (IPMN EN) and PD was performed in 100 (IPMN PD) with 17 of these radiographically amenable to EN (IPMN PDen). During the same time period, 281 patients underwent PD for PA (Control PD). Results: Operative time was shorter (p < 0.05) and blood loss (p < 0.05) was less in the IPMN EN group compared with all other groups. Peri-operative mortality and morbidity of all IPMN groups (IPMN EN, IPMN PDen) were similar to the Control PD group. Overall pancreatic fistulae rate in the IPMN EN group was higher than in the IPMN PDen and Control PD groups; however, the rate of grade C pancreatic fistulae was the same in all groups. Conclusions: Pancreaticoduodenectomy for side-branch IPMNs can be performed safely. Compared with PD, enucleation for IPMN has less blood loss, shorter operative time and similar morbidity, mortality, hospital length of stay (LOS) and readmission rate. Enucleation should be considered more frequently as an option for patients with unifocal side-branch IPMN.

Original languageEnglish
Pages (from-to)126-131
Number of pages6
JournalHPB
Volume13
Issue number2
DOIs
StatePublished - Feb 2011

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Pancreaticoduodenectomy
Head and Neck Neoplasms
Pancreatic Neoplasms
Neoplasms
Pancreatic Fistula
Operative Time
Length of Stay
Adenocarcinoma
Morbidity
Patient Readmission
Control Groups
Mortality

Keywords

  • cystic tumours
  • outcomes
  • resection

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Turrini, O., Schmidt, C., Pitt, H. A., Guiramand, J., Aguilar-Saavedra, J. R., Aboudi, S., ... Delpero, J. R. (2011). Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: Resection or enucleation? HPB, 13(2), 126-131. https://doi.org/10.1111/j.1477-2574.2010.00256.x

Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate : Resection or enucleation? / Turrini, Olivier; Schmidt, C.; Pitt, Henry A.; Guiramand, Jerome; Aguilar-Saavedra, Juan R.; Aboudi, Shadi; Lillemoe, Keith D.; Delpero, Jean Robert.

In: HPB, Vol. 13, No. 2, 02.2011, p. 126-131.

Research output: Contribution to journalArticle

Turrini, O, Schmidt, C, Pitt, HA, Guiramand, J, Aguilar-Saavedra, JR, Aboudi, S, Lillemoe, KD & Delpero, JR 2011, 'Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: Resection or enucleation?', HPB, vol. 13, no. 2, pp. 126-131. https://doi.org/10.1111/j.1477-2574.2010.00256.x
Turrini, Olivier ; Schmidt, C. ; Pitt, Henry A. ; Guiramand, Jerome ; Aguilar-Saavedra, Juan R. ; Aboudi, Shadi ; Lillemoe, Keith D. ; Delpero, Jean Robert. / Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate : Resection or enucleation?. In: HPB. 2011 ; Vol. 13, No. 2. pp. 126-131.
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abstract = "Introduction: Side-branch intraductal papillary mucinous neoplasms (IPMN) of the pancreatic head/uncinate are an increasingly common indication for pancreaticoduodenectomy (PD). However, enucleation (EN) may be an alternative to PD in selected patients to improve outcomes and preserve pancreatic parenchyma. Aim: To determine peri-operative outcomes in patients with side-branch IPMN of the pancreatic head/uncinate undergoing EN or PD compared with a cohort of patients with pancreatic adenocarcinoma (PA) undergoing PD. Methods: Retrospective review of a prospectively collected, combined, academic institutional series from 2005 to 2008. Of 107 pancreatic head/uncinate IPMN, enucleation was performed in 7 (IPMN EN) and PD was performed in 100 (IPMN PD) with 17 of these radiographically amenable to EN (IPMN PDen). During the same time period, 281 patients underwent PD for PA (Control PD). Results: Operative time was shorter (p < 0.05) and blood loss (p < 0.05) was less in the IPMN EN group compared with all other groups. Peri-operative mortality and morbidity of all IPMN groups (IPMN EN, IPMN PDen) were similar to the Control PD group. Overall pancreatic fistulae rate in the IPMN EN group was higher than in the IPMN PDen and Control PD groups; however, the rate of grade C pancreatic fistulae was the same in all groups. Conclusions: Pancreaticoduodenectomy for side-branch IPMNs can be performed safely. Compared with PD, enucleation for IPMN has less blood loss, shorter operative time and similar morbidity, mortality, hospital length of stay (LOS) and readmission rate. Enucleation should be considered more frequently as an option for patients with unifocal side-branch IPMN.",
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AU - Turrini, Olivier

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AU - Pitt, Henry A.

AU - Guiramand, Jerome

AU - Aguilar-Saavedra, Juan R.

AU - Aboudi, Shadi

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AU - Delpero, Jean Robert

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N2 - Introduction: Side-branch intraductal papillary mucinous neoplasms (IPMN) of the pancreatic head/uncinate are an increasingly common indication for pancreaticoduodenectomy (PD). However, enucleation (EN) may be an alternative to PD in selected patients to improve outcomes and preserve pancreatic parenchyma. Aim: To determine peri-operative outcomes in patients with side-branch IPMN of the pancreatic head/uncinate undergoing EN or PD compared with a cohort of patients with pancreatic adenocarcinoma (PA) undergoing PD. Methods: Retrospective review of a prospectively collected, combined, academic institutional series from 2005 to 2008. Of 107 pancreatic head/uncinate IPMN, enucleation was performed in 7 (IPMN EN) and PD was performed in 100 (IPMN PD) with 17 of these radiographically amenable to EN (IPMN PDen). During the same time period, 281 patients underwent PD for PA (Control PD). Results: Operative time was shorter (p < 0.05) and blood loss (p < 0.05) was less in the IPMN EN group compared with all other groups. Peri-operative mortality and morbidity of all IPMN groups (IPMN EN, IPMN PDen) were similar to the Control PD group. Overall pancreatic fistulae rate in the IPMN EN group was higher than in the IPMN PDen and Control PD groups; however, the rate of grade C pancreatic fistulae was the same in all groups. Conclusions: Pancreaticoduodenectomy for side-branch IPMNs can be performed safely. Compared with PD, enucleation for IPMN has less blood loss, shorter operative time and similar morbidity, mortality, hospital length of stay (LOS) and readmission rate. Enucleation should be considered more frequently as an option for patients with unifocal side-branch IPMN.

AB - Introduction: Side-branch intraductal papillary mucinous neoplasms (IPMN) of the pancreatic head/uncinate are an increasingly common indication for pancreaticoduodenectomy (PD). However, enucleation (EN) may be an alternative to PD in selected patients to improve outcomes and preserve pancreatic parenchyma. Aim: To determine peri-operative outcomes in patients with side-branch IPMN of the pancreatic head/uncinate undergoing EN or PD compared with a cohort of patients with pancreatic adenocarcinoma (PA) undergoing PD. Methods: Retrospective review of a prospectively collected, combined, academic institutional series from 2005 to 2008. Of 107 pancreatic head/uncinate IPMN, enucleation was performed in 7 (IPMN EN) and PD was performed in 100 (IPMN PD) with 17 of these radiographically amenable to EN (IPMN PDen). During the same time period, 281 patients underwent PD for PA (Control PD). Results: Operative time was shorter (p < 0.05) and blood loss (p < 0.05) was less in the IPMN EN group compared with all other groups. Peri-operative mortality and morbidity of all IPMN groups (IPMN EN, IPMN PDen) were similar to the Control PD group. Overall pancreatic fistulae rate in the IPMN EN group was higher than in the IPMN PDen and Control PD groups; however, the rate of grade C pancreatic fistulae was the same in all groups. Conclusions: Pancreaticoduodenectomy for side-branch IPMNs can be performed safely. Compared with PD, enucleation for IPMN has less blood loss, shorter operative time and similar morbidity, mortality, hospital length of stay (LOS) and readmission rate. Enucleation should be considered more frequently as an option for patients with unifocal side-branch IPMN.

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