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World Journal of Surgery
Erschienen in: World Journal of Surgery 6/2015

01.06.2015 | Scientific Review

Limited Surgery for Benign Tumours of the Pancreas: A Systematic Review

verfasst von: H. G. Beger, M. Siech, B. Poch, B. Mayer, M. H. Schoenberg

Erschienen in: World Journal of Surgery | Ausgabe 6/2015

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Abstract

Background

Limited surgical procedures for benign cystic neoplasms and endocrine tumours of the pancreas have the potential advantage of pancreatic tissue sparing compared to standard oncological resections.

Methods

Searching PubMed/MedLine, Embase and Cochrane Library identified 86 full papers: 25 reporting on enucleation (EN), 38 on central pancreatectomy (CP) and 23 on duodenum-preserving total/partial pancreatic head resection (DPPHRt/p). The results are based on analysis of data of 838, 912 and 431 patients for EN, CP and DPPHRt/s, respectively.

Results

The indication for EN for cystic neoplasms and neuro-endocrine tumours to EN was 20.5 and 73 %; for CP 62.9 and 31 %; and for DPPHRt/p 69.6 and 10.2 %, respectively. The estimated mean tumour sizes were in EN-group 2.4 cm, in CP-group 2.9 cm and in DPPHRt/p-group 3.1 cm (DPPHRt/p vs EN, p = 0.035). Postoperative severe complications developed after EN, CP and DPPHRt/p in 9.6, 16.8 and 11.5 % of patients; pancreatic fistula in 36.7, 35.2 and 20.1 %; and reoperation was required in 4.7, 6.5 and 1.8 %, respectively. Hospital mortality after EN was 0.95 %; after CP 0.72 %; and after DPPHRt/p 0.49 %. Compared to EN and CP, DPPHRt/p exhibited significant lower frequency of reoperation (p = 0.029, p < 0.001) and lower rate of fistula (p < 0.001; p = 0.001).

Conclusion

EN, CP and DPPHRt/p applied for benign tumours are associated with low surgery-related early postoperative morbidity, a very low hospital mortality and the advantages of conservation of pancreatic functions. However, the level of evidence for EN and CP compared to standard oncological resections appears presently low. There is a high level of evidence from prospective controlled trials regarding the significant maintenance of exocrine and endocrine pancreatic functions after DPPHRt/p compared to pancreato-duodenectomy.
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Metadaten
Titel
Limited Surgery for Benign Tumours of the Pancreas: A Systematic Review
verfasst von
H. G. Beger
M. Siech
B. Poch
B. Mayer
M. H. Schoenberg
Publikationsdatum
01.06.2015
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 6/2015
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-015-2976-x

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