title: Laparoscopic Hand-Assisted Parenchymal-Sparing Resections for Presumed Side-Branch Intraductal Papillary Mucinous Neoplasms.
abstract: BACKGROUND
  The diagnosis of side-branch intraductal papillary mucinous neoplasms (IMPNs) is increasingly more common, but their appropriate management is still evolving. We recently began performing laparoscopic hand-assisted enucleation or duodenal-sparing pancreatic head resection for these lesions with vigilant postoperative imaging.
  
  
  METHODS
  Seventeen patients with pancreatic cystic lesions were included in this single-center retrospective review from January 1, 2008 to March 30, 2013. Indication for surgical intervention was growth in size of the cyst, symptoms, cyst size >3 cm, and/or presence of a mural nodule. Twelve patients underwent laparoscopic hand-assisted enucleation, and 5 patients underwent laparoscopic hand-assisted pancreatic head resection.
  
  
  RESULTS
  The mean age of patients was 64 years old. The most common presenting symptom was abdominal pain. The indication for surgical intervention was growth in the cyst or symptoms in the majority of patients. Fourteen lesions were in the head/uncinate, two were in the pancreatic body, and one was in the tail. Final pathology was consistent with side-branch IPMN in 13 patients (1 with focal adenocarcinoma). Three patients had serous cysts, and 1 had a mucinous cyst. Three patients developed pancreatic leaks, which were controlled with intraoperative placed drains, whereas 1 patient required additional drain placement. Median time from surgery to latest follow-up imaging is over 2 years. No patients have developed recurrent cysts or adenocarcinoma.
  
  
  CONCLUSIONS
  Duodenal-sparing pancreatic head resection or pancreatic enucleation for patients with presumed side-branch IPMN is a safe and efficacious option, in terms of both operative outcomes and postoperative recurrence risk.
authors.affiliation: 1 Division of Transplantation and Hepatobiliary Surgery, Department of Surgery, University of Florida , Gainesville, Florida.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Thomas
authors.affiliation: 2 Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck Medical Center of University of Southern California , Los Angeles, California.
authors.forename: Lea
authors.initials: L
authors.lastname: Matsuoka
authors.affiliation: 2 Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck Medical Center of University of Southern California , Los Angeles, California.
authors.forename: Sophoclis
authors.initials: S
authors.lastname: Alexopoulos
authors.affiliation: 2 Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck Medical Center of University of Southern California , Los Angeles, California.
authors.forename: Rick
authors.initials: R
authors.lastname: Selby
authors.affiliation: 2 Division of Hepatobiliary, Pancreas, and Abdominal Organ Transplant, Department of Surgery, Keck Medical Center of University of Southern California , Los Angeles, California.
authors.forename: Dilip
authors.initials: D
authors.lastname: Parekh
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology / Q000601:surgery*; D057868:Anastomotic Leak / Q000209:etiology; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D004386:Duodenum / Q000601:surgery; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods*; D010181:Pancreatic Cyst / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies