title: Systematic Review and Meta-Analysis of Enucleation Versus Standardized Resection for Small Pancreatic Lesions.
abstract: BACKGROUND
  The appropriate surgical strategy in patients with small pancreatic lesions of low malignant potential, such as pancreatic neuroendocrine tumors, remains unknown. Increasing reports suggest limited pancreatic surgery may be a safe option for parenchymal preservation.
  
  
  METHODS
  PubMed and MEDLINE were searched in the English literature for studies from January 2000 to February 2015 examining enucleation for pancreatic lesions that were single-arm and comparative studies (versus resection). Single-arm enucleation studies were systematically reviewed. Comparative studies were included for meta-analysis. Endpoints include safety, complications, mortality, survival, and parenchymal-related outcomes.
  
  
  RESULTS
  Thirteen studies comprising of 1101 patients undergoing enucleation were included. Seven studies were comparative studies of enucleation and standardized pancreatic resection. Enucleation was a shorter procedure (pooled mean differences (MD) = 109, 95 % confidence interval (CI) 105-114; Z = 46.37; P < 0.001) associated with less blood loss (pooled MD = 314, 95 % CI 297-330; Z = 37.47; P < 0.001). Both enucleation and resection had similar mortality and complication rates, but the rate of pancreatic fistula (all grades) (pooled odds ratio (OR) = 1.99; 95 % CI 1.2-3.4; Z = 2.57; P = 0.01] and rate of pancreatic fistula (grade B/C) (pooled OR = 1.58; 95 % CI 1.0-2.5; Z = 2.06; P = 0.04) was higher in the enucleation group. Enucleation resulted in lower rates of endocrine (pooled OR = 0.22; 95 % CI 0.1-0.5; Z = 3.21; P = 0.001) and exocrine (pooled OR = 0.07; 95 % CI 0.02-0.2; Z = 5.08; P < 0.001) insufficiency. The median 5-year survival was 95 % (range 93-98) and 84 % (range 79-90).
  
  
  CONCLUSIONS
  Enucleation appears to be a safe procedure and achieves parenchymal preservation for small pancreatic lesions of low malignant potential. Its oncologic efficacy compared with standardized pancreatic resection with respect to long-term survival and recurrences have not been reported adequately and hence may not be concluded as being comparable.
authors: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia. terence.c.chua@gmail.com.|Discipline of Surgery, University of Sydney, Sydney, NSW, Australia. terence.c.chua@gmail.com.
authors: Terence C
authors: TC
authors: Chua
authors: Department of Gastrointestinal Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia.|Discipline of Surgery, University of Sydney, Sydney, NSW, Australia.
authors: Timothy X
authors: TX
authors: Yang
authors: Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, St Leonards, NSW, Australia.|University of Sydney, Sydney, NSW, Australia.|Deparment of Anatomical Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors: Anthony J
authors: AJ
authors: Gill
authors: Macquarie University Hospital, Macquarie University, Sydney, NSW, Australia. jas.samra@bigpond.com.|Department of Gastrointestinal Surgery, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia. jas.samra@bigpond.com.
authors: Jaswinder S
authors: JS
authors: Samra
mesh_terms: D015353:Eye Enucleation; D006801:Humans; D010180:Pancreatectomy / Q000145:classification* / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D013514:Surgical Procedures, Operative