BACKGROUND The role of enucleation (EN) for branch duct intraductal papillary mucinous neoplasms (BD-IPMN) is poorly defined. This systematic review aims to review EN for BD-IPMN and compare it with pancreatic resection (pancreaticoduodenectomy, distal pancreatectomy and central pancreatectomy). METHODS A systematic review of published literature was performed using PRISMA guidelines, and included a search of PubMed, MEDLINE and SCOPUS databases. RESULTS Sixteen studies were included in the final analysis comprising 991 patients with 293 EN patients and 698 resected patients. EN was most often performed for low grade (77%, 151/197) BD-IPMN's (99%, 251/253) of the pancreatic head (64%, 106/165), with a pooled mean diameter of 21 mm (SD 28 mm). EN was a shorter procedure (MD -115.8 min, CI -142.2 to -89.5 min, P=<0.001) with a lower rate of post-pancreatectomy haemorrhage (EN 1% 2/144, Resection 5% 10/186, RR 0.32, CI 0.11 to 0.94, P = 0.043) and postoperative exocrine and endocrine insufficiency (P = <0.001 and P = 0.003 respectively) than resection. CONCLUSION EN for BD-IPMN's appears to be a reasonable alternative to resection in low risk BD-IPMN's, allowing preservation of exocrine and endocrine function with comparable reoperation and recurrence rates to resection. However, surveillance was indicated in these low risk patients based on current published guidelines.

中文翻译：

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分支导管导管内乳头状粘液性肿瘤的去核：系统评价和荟萃分析。

背景摘除术（EN）在分支导管导管内乳头状黏液性肿瘤（BD-IPMN）中的作用定义不清。本系统综述旨在综述BD-IPMN的EN，并将其与胰腺切除术（胰十二指肠切除术，远端胰腺切除术和中央胰腺切除术）进行比较。方法使用PRISMA指南对发表的文献进行系统的综述，包括对PubMed，MEDLINE和SCOPUS数据库的搜索。结果最终分析包括16项研究，包括991例293例EN患者和698例被切除的患者。EN最常用于胰头（64％，106/165）的低级别（77％，151/197）BD-IPMN（99％，251/253），合并平均直径为21 mm（SD 28毫米）。EN是一个较短的程序（MD -115.8分钟，CI -142.2至-89.5分钟，P = <0。001）胰腺切除术后出血的发生率较低（EN 1％2/144，切除5％10/186，RR 0.32，CI 0.11至0.94，P = 0.043）和术后外分泌和内分泌功能不全（P = <0.001和P分别为0.003）。结论BD-IPMN的EN似乎是低危BD-IPMN切除的合理替代方案，可以保留外分泌和内分泌功能，并具有与切除术相当的再次手术和复发率。但是，根据当前发布的指南，对这些低危患者进行了监测。在低风险的BD-IPMN中，s似乎是切除的合理选择，可以保留外分泌和内分泌功能，并且具有与切除术相当的再次手术和复发率。但是，根据当前发布的指南，对这些低危患者进行了监测。在低风险的BD-IPMN中，s似乎是切除的合理选择，可以保留外分泌和内分泌功能，并且具有与切除术相当的再次手术和复发率。但是，根据当前发布的指南，对这些低危患者进行了监测。