title: Technical Feasibility and Oncological Legitimacy of Enucleation of Intraductal Papillary Mucinous Neoplasm Located at the Pancreatic Head or Uncinate Process.
abstract: Surgical indications and strategies for branch duct (BD)-intraductal papillary mucinous neoplasm (IPMN) at the pancreatic head (PH) are controversial issues. We investigated the technical feasibility and oncological legitimacy of enucleation for IPMN of the PH.
  
  
  
  The clinicopathological parameters of 11 patients with IPMN who underwent conventional pancreaticoduodenectomy (PD, n=7) or enucleation (n=4) during the same period were evaluated.
  
  
  
  The mean operative time (442 vs. 280 min, p<0.05) and blood loss (864 vs. 93 ml, p<0.05) were significantly better in the enucleation group. The final pathological diagnosis (low-/intermediate-/high-grade dysplasia) in the PD and enucleation groups was 4/2/1 and 3/1/0, respectively. The incidence of grade B pancreatic fistula and Clavien III complications was 14% vs. 0% and 43% vs. 25%, respectively. No recurrent pancreatitis or exocrine or endocrine dysfunction was noted in the enucleation group; however, de novo or exacerbated diabetes mellitus developed in three patients in the PD group. All patients were alive and no disease recurrence was noted at a mean follow-up of 1,059 days.
  
  
  
  Enucleation of BD-IPMN at the PH is a technically feasible and oncologically acceptable procedure which should be justified in patients with IPMNs with a low risk of malignancy.
authors.affiliation: Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.|Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.affiliation: Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Toshima
authors.affiliation: Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Motomura
authors.affiliation: Department of Hepatobiliary and Pancreatic Medicine, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yokota
authors.affiliation: Department of Hepatobiliary and Pancreatic Medicine, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Kouji
authors.initials: K
authors.lastname: Joko
authors.affiliation: Department of Pathology, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Oshiro
authors.affiliation: Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Takahashi
authors.affiliation: Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishizaki
authors.affiliation: Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ysoejima@surg2.med.kyushu-u.ac.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Intraductal papillary mucinous neoplasm; enucleation; limited resection; pancreatic head; uncinate process