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. 2022 Jan 26:8:744316.
doi: 10.3389/fsurg.2021.744316. eCollection 2021.

Comparison of Outcomes of Enucleation vs. Standard Surgical Resection for Pancreatic Neoplasms: A Systematic Review and Meta-Analysis

Xiaoying Shen  1 , Xiaomao Yang  1
Affiliations

Comparison of Outcomes of Enucleation vs. Standard Surgical Resection for Pancreatic Neoplasms: A Systematic Review and Meta-Analysis

Xiaoying Shen et al. Front Surg. .

Abstract

Background: With advancement in health technology, the detection rate of pancreatic neoplasms is increasing. Tissue sparing surgery (enucleation) as well as standard surgical resection are two commonly used modalities of management. There are studies comparing clinical outcomes between these two modalities; however, there is lack of studies that systematically pool the available findings to present conclusive and reliable evidence.

Methods: A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies that were randomised controlled trials or cohort based or analysed retrospective data were considered for inclusion. Studies should have been done in adult patients with pancreatic neoplasms and should have examined the outcomes of interest by the two management modalities i.e., enucleation and standard surgical resection. Statistical analysis was performed using STATA software.

Results: A total of 20 studies were included in the meta-analysis. The operation time (in minutes) (WMD -78.20; 95% CI: -89.47, -66.93) and blood loss (in ml) (WMD -204.30; 95% CI: -281.70, -126.90) for enucleation was significantly lesser than standard surgical resection. The risk of endocrine (RR 0.32; 95% CI: 0.18, 0.56) and exocrine insufficiency (RR 0.16; 95% CI: 0.07, 0.34) was lower whereas the risk of post-operative pancreatic fistula (RR 1.46; 95% CI: 1.22, 1.75) was higher in enucleation, compared to standard surgical resection group. There were no differences in the risk of reoperation, readmission, recurrence, mortality within 90 days and 5-years overall mortality between the two groups.

Conclusions: Enucleation, compared to standard surgical resection, was associated with better clinical outcomes and therefore, might be considered for selected pancreatic neoplasms. There is a need for randomised controlled trials to document the efficacy of these two management techniques.

Keywords: enucleation; meta-analysis; pancreatic neoplasm; surgical resection; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Selection process of the studies included in the review.
Figure 2
Figure 2
Comparison of operation time (in minutes) between enucleation and standard surgical resection.
Figure 3
Figure 3
Comparison of blood loss (in ml) between enucleation and standard surgical resection.
Figure 4
Figure 4
Comparison of length of hospital stay (in days) between enucleation and standard surgical resection.
Figure 5
Figure 5
Comparison of risk of reoperation, readmission, endocrine insufficiency and exocrine insufficiency between enucleation and standard surgical resection.
Figure 6
Figure 6
Comparison of risk of complications between enucleation and standard surgical resection.
Figure 7
Figure 7
Comparison of risk of recurrence, death within 90 days of operation and 5-years overall survival between enucleation and standard surgical resection.
See this image and copyright information in PMC

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