Skip to main content
Top
Published in: Journal of Gastrointestinal Surgery 12/2013

01-12-2013 | Original Article

Enucleation of Pancreatic Lesions: Indications, Outcomes, and Risk Factors for Clinical Pancreatic Fistula

Authors: Taiping Zhang, Jianwei Xu, Tianxiao Wang, Quan Liao, Menghua Dai, Yupei Zhao

Published in: Journal of Gastrointestinal Surgery | Issue 12/2013

Login to get access

Abstract

Background

There are few large samples and single-center series that focus on the outcomes of pancreatic enucleation and risk factors for clinical pancreatic fistula (PF). This study aimed to evaluate the indications, short- and long-term results, and risk factors for clinical PF after pancreatic enucleation.

Methods

Patients who underwent pancreatic enucleation from January 2005 to April 2011 at the Peking Union Medical College Hospital in China were included. Clinical data were collected and analyzed.

Results

A total of 119 patients underwent enucleation. PF was the most common complication; the incidence of clinical PF (grades B and C) was 27.7 %. The most common indications were endocrine neoplasms (76.5 %). During a median follow-up of 41 months, no patient developed exocrine insufficiency. Three elderly patients developed non-insulin-dependent diabetes mellitus. One patient with VIPoma developed recurrence and liver metastasis. New York Heart Association (NYHA) class II or III (P = 0.009; hazard ratio (HR) 3.191; 95 % confidence interval (CI) 1.334–7.632), operative time ≥180 min (P = 0.025; HR 2.664; 95 % CI 1.112–6.386) were the independent risk factors for clinical PF.

Conclusion

Enucleation is a safe and effective treatment for benign and low malignant lesions of the pancreas. NYHA class II or III and operation time of ≥180 min are independent risk factors for clinical PF.
Literature
1.
go back to reference Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, et al. Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbecks Arch Surg 2011;396:1197–203.PubMedCrossRef Hackert T, Hinz U, Fritz S, Strobel O, Schneider L, Hartwig W, et al. Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbecks Arch Surg 2011;396:1197–203.PubMedCrossRef
2.
go back to reference Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg 2007;94:1254–9.PubMedCrossRef Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P. Enucleation of pancreatic neoplasms. Br J Surg 2007;94:1254–9.PubMedCrossRef
3.
go back to reference Crippa S, Boninsegna L, Partelli S, Falconi M. Parenchyma-sparing resections for pancreatic neoplasms. J Hepatobiliary Pancreat Sci 2010;17:782–7.PubMedCrossRef Crippa S, Boninsegna L, Partelli S, Falconi M. Parenchyma-sparing resections for pancreatic neoplasms. J Hepatobiliary Pancreat Sci 2010;17:782–7.PubMedCrossRef
4.
go back to reference Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM, et al. Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate. J Gastrointest Surg 2009;13:1692–8.PubMedCrossRef Pitt SC, Pitt HA, Baker MS, Christians K, Touzios JG, Kiely JM, et al. Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate. J Gastrointest Surg 2009;13:1692–8.PubMedCrossRef
5.
go back to reference Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, et al. Cystadenomas of the pancreas: is enucleation an adequate operation. Ann Surg 1998;227:896–903.PubMedCrossRef Talamini MA, Moesinger R, Yeo CJ, Poulose B, Hruban RH, Cameron JL, et al. Cystadenomas of the pancreas: is enucleation an adequate operation. Ann Surg 1998;227:896–903.PubMedCrossRef
6.
go back to reference Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, Capitanio V, et al. Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol 2010;17:1621–7.PubMedCrossRef Falconi M, Zerbi A, Crippa S, Balzano G, Boninsegna L, Capitanio V, et al. Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann Surg Oncol 2010;17:1621–7.PubMedCrossRef
7.
go back to reference Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect. J Gastrointest Surg 2003;7:890–7.PubMedCrossRef Kiely JM, Nakeeb A, Komorowski RA, Wilson SD, Pitt HA. Cystic pancreatic neoplasms: enucleate or resect. J Gastrointest Surg 2003;7:890–7.PubMedCrossRef
8.
go back to reference Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.PubMedCrossRef Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.PubMedCrossRef
9.
go back to reference Brient C, Regenet N, Sulpice L, Brunaud L, Mucci-Hennekine S, Carrere N, et al. Risk factors for postoperative pancreatic fistulization subsequent toenucleation. J Gastrointest Surg 2012;16:1883–7.PubMedCrossRef Brient C, Regenet N, Sulpice L, Brunaud L, Mucci-Hennekine S, Carrere N, et al. Risk factors for postoperative pancreatic fistulization subsequent toenucleation. J Gastrointest Surg 2012;16:1883–7.PubMedCrossRef
10.
go back to reference Hurst JW. The value of using the entire New York Heart Association’s classification of heart and vascular disease. Clin Cardiol 2006;29:415–7.PubMedCrossRef Hurst JW. The value of using the entire New York Heart Association’s classification of heart and vascular disease. Clin Cardiol 2006;29:415–7.PubMedCrossRef
11.
go back to reference Ehehalt F, Saeger HD, Schmidt CM, Grutzmann R. Neuroendocrine tumors of the pancreas. Oncologist 2009;14:456–67.PubMedCrossRef Ehehalt F, Saeger HD, Schmidt CM, Grutzmann R. Neuroendocrine tumors of the pancreas. Oncologist 2009;14:456–67.PubMedCrossRef
12.
go back to reference Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–13.PubMedCrossRef
13.
go back to reference Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 2010;34:121–5.PubMedCrossRef Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 2010;34:121–5.PubMedCrossRef
14.
go back to reference Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definitionby the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761–8.PubMedCrossRef Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definitionby the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761–8.PubMedCrossRef
15.
16.
go back to reference Pongpornsup S, Piyapittayanan S, Charoensak A. MDCT imaging findings for characterization pancreatic cystic lesion: differentiation between benign and malignant pattern. J Med Assoc Thai 2011;94:369–78.PubMed Pongpornsup S, Piyapittayanan S, Charoensak A. MDCT imaging findings for characterization pancreatic cystic lesion: differentiation between benign and malignant pattern. J Med Assoc Thai 2011;94:369–78.PubMed
17.
go back to reference Ge C, Luo X, Chen X, Guo K. Enucleation of pancreatic cystadenomas. J Gastrointest Surg 2010;14:141–7.PubMedCrossRef Ge C, Luo X, Chen X, Guo K. Enucleation of pancreatic cystadenomas. J Gastrointest Surg 2010;14:141–7.PubMedCrossRef
18.
go back to reference Turrini O, Schmidt CM, Pitt HA, Guiramand J, Aguilar-Saavedra JR, Aboudi S, et al. Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation. HPB (Oxford) 2011;13:126–31.CrossRef Turrini O, Schmidt CM, Pitt HA, Guiramand J, Aguilar-Saavedra JR, Aboudi S, et al. Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation. HPB (Oxford) 2011;13:126–31.CrossRef
19.
go back to reference Butte JM, Brennan MF, Gonen M, Tang LH, D’Angelica MI, Fong Y, et al. 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 2011;15:350–7.PubMedCrossRef Butte JM, Brennan MF, Gonen M, Tang LH, D’Angelica MI, Fong Y, et al. 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 2011;15:350–7.PubMedCrossRef
20.
go back to reference Takamatsu S, Nagano H, Ohtsukasa S, Kawachi Y, Maruyama H. A case of spontaneous ruptured solid pseudopapillary tumor of pancreas resected by laparoscopic surgery. Case Rep Med 2013;2013:953240.PubMed Takamatsu S, Nagano H, Ohtsukasa S, Kawachi Y, Maruyama H. A case of spontaneous ruptured solid pseudopapillary tumor of pancreas resected by laparoscopic surgery. Case Rep Med 2013;2013:953240.PubMed
21.
go back to reference Smith SL, Branton SA, Avino AJ, Martin JK, Klingler PJ, Thompson GB, et al. Vasoactive intestinal polypeptide secreting islet cell tumors: a 15-year experience and review of the literature. Surgery 1998;124:1050–5.PubMedCrossRef Smith SL, Branton SA, Avino AJ, Martin JK, Klingler PJ, Thompson GB, et al. Vasoactive intestinal polypeptide secreting islet cell tumors: a 15-year experience and review of the literature. Surgery 1998;124:1050–5.PubMedCrossRef
22.
go back to reference Pecorelli N, Balzano G, Capretti G, Zerbi A, Di CV, Braga M. Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital. J Gastrointest Surg 2012;16:518–23.PubMedCrossRef Pecorelli N, Balzano G, Capretti G, Zerbi A, Di CV, Braga M. Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital. J Gastrointest Surg 2012;16:518–23.PubMedCrossRef
23.
go back to reference Sierzega M, Niekowal B, Kulig J, Popiela T. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Cull Surg 2007;205:52–9.CrossRef Sierzega M, Niekowal B, Kulig J, Popiela T. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Cull Surg 2007;205:52–9.CrossRef
24.
go back to reference Carter TI, Fong ZV, Hyslop T, Lavu H, Tan WP, Hardacre J, et al. A dual-institution randomized controlled trial of remnant closure after distal pancreatectomy: does the addition of a filiform patch and fibrin glue improve outcomes. J Gastrointest Surg 2013;17:102–9.PubMedCrossRef Carter TI, Fong ZV, Hyslop T, Lavu H, Tan WP, Hardacre J, et al. A dual-institution randomized controlled trial of remnant closure after distal pancreatectomy: does the addition of a filiform patch and fibrin glue improve outcomes. J Gastrointest Surg 2013;17:102–9.PubMedCrossRef
25.
26.
go back to reference Ausania F, Snowden CP, Prentis JM, Holmes LR, Jaques BC, White SA, et al. Effects of low cardiopulmonary reserve on pancreatic leak following pancreaticoduodenectomy. Br J Surg 2012;99:1290–4.PubMedCrossRef Ausania F, Snowden CP, Prentis JM, Holmes LR, Jaques BC, White SA, et al. Effects of low cardiopulmonary reserve on pancreatic leak following pancreaticoduodenectomy. Br J Surg 2012;99:1290–4.PubMedCrossRef
27.
go back to reference Lermite E, Pessaux P, Brehant O, Teyssedou C, Pelletier I, Etienne S, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 2007;204:588–96.PubMedCrossRef Lermite E, Pessaux P, Brehant O, Teyssedou C, Pelletier I, Etienne S, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 2007;204:588–96.PubMedCrossRef
28.
go back to reference Zhao YP, Zhan HX, Cong L, Zhang TP, Liao Q, Dai MH, et al. Risk factors for postoperative pancreatic fistula in patients with insulinomas: analysis of 292 consecutive cases. Hepatobiliary Pancreat Dis Int 2012;11:102–6.PubMedCrossRef Zhao YP, Zhan HX, Cong L, Zhang TP, Liao Q, Dai MH, et al. Risk factors for postoperative pancreatic fistula in patients with insulinomas: analysis of 292 consecutive cases. Hepatobiliary Pancreat Dis Int 2012;11:102–6.PubMedCrossRef
Metadata
Title
Enucleation of Pancreatic Lesions: Indications, Outcomes, and Risk Factors for Clinical Pancreatic Fistula
Authors
Taiping Zhang
Jianwei Xu
Tianxiao Wang
Quan Liao
Menghua Dai
Yupei Zhao
Publication date
01-12-2013
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 12/2013
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-013-2355-6

Other articles of this Issue 12/2013

Journal of Gastrointestinal Surgery 12/2013 Go to the issue