imaging Paradigm of Cystic Lesions in Pancreas

There has been a significant increase in the usage of advanced diagnostic imaging modalities, with almost tripling the use of multi-detector computed tomography (MDCT), magnetic resonance imaging (MRI) and magnetic resonance cholangio-pancreatography (MRCP) in the last two decades. With this increasing use of radiology resources, there has been an overall increase in healthcare costs.

The detection of incidental pancreatic cysts has increased which not only is scary for the patient but also adds anxiety to the gastroenterologist, pathologist and the radiologist. The gamut of pancreatic cysts can span from benign to borderline malignant to frankly malignant cysts. Accurate preoperative imaging diagnosis of these pancreatic cystic lesions is essential so as to reduce unnecessary intervention, healthcare costs and also guide the clinician and the patient for follow-up imaging if required.

We made a literature review of articles published in English language using PubMed-library database search between the time periods January 2010 to April 2016. The following individual and combined keywords were used: cystic, lesions, tumours, pancreas, imaging, radiology. We also reviewed the citations of the references obtained from the articles. From a total of 139 articles, only 98 related articles were selected.

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Side-Branch Intraductal Papillary Mucinous Neoplasms of the Pancreas: Enucleation or Standard Pancreatic Resection: Systematic Review with Meta-Analysis

Background Side-branch intraductal papillary mucinous neoplasms of the pancreas have a low malignant potential, usually treated by pancreatic resection. Less invasive surgery, including enucleation, has been introduced for management of benign intraductal papillary mucinous neoplasms to decrease postoperative mortality and morbidity.

This study aimed to compare enucleation to pancreatic resection for side-branch intraductal papillary mucinous neoplasms of the pancreas regarding risk of mortality and morbidity. Methods An extensive electronic search of the relevant literature was performed using the following databases: Medline, the Cochrane Library, Scopus, Embase and the Web of Science. Results Nineteen studies were retrieved. Only Four studies met eligible criteria. There were one prospective non-randomized study and three retrospective comparative studies.

We performed a meta-analysis using Review manager 5.1. Conclusion This study showed that enucleation for side-branch intraductal papillary mucinous neoplasms provides more recurrence and post-operative pancreatic fistula than pancreatic resection without reaching the level of significance. On the other hand, enucleation provides less mortality, overall morbidity, and reoperation rates than pancreatic resection without reaching the level of significance for all comparisons.

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Side-Branch Intraductal of the Pancreas: Enucleation or Standard Pancreatic Resection: Systematic Review with Meta-Analysis

Side-branch intraductal papillary mucinous neoplasms (side-branch IPMN) of the pancreas have a low malignant potential. The conventional treatment for this lesion, according to location, if there are signs of possible malignancy, has been pancreaticoduodenectomy (PD), total pancreatectomy (P), central pancreatectomy (CP) or distal pancreatectomy (DP).

Despite advances reported in recent years, standard pancreatectomies still carry a significant postoperative mortality ranging from 1 % to 4 %. These interventions are also associated with high postoperative morbidity and long-term disorders such as diabetes [4] and exocrine insufficiency. Less invasive surgery, including enucleation (EN) and resection of ucinate process (RUP), has been introduced for management of benign IPMN to preserve pancreatic function postoperatively and decrease postoperative mortality and morbidity.

However, recommendations and reports of postoperative complications and clinical outcomes following these procedures have been limited. The debate between PR and EN is still a challenge for surgeons. At our knowledge, this is the first meta-analysis to compare EN to PR for the treatment of side-branch IPMN.This systematic review aimed to determine whether the EN is associated or not with a higher risk of mortality and morbidity compared to PR techniques for side-branch IPMN of the pancreas.

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Side-Branch Intraductal of the Pancreas: Enucleation or Standard Pancreatic Resection: Systematic Review with Meta-Analysis

Side-branch intraductal papillary mucinous neoplasms (side-branch IPMN) of the pancreas have a low malignant potential. The conventional treatment for this lesion, according to location, if there are signs of possible malignancy, has been pancreaticoduodenectomy (PD), total pancreatectomy (P), central pancreatectomy (CP) or distal pancreatectomy (DP).

Despite advances reported in recent years, standard pancreatectomies still carry a significant postoperative mortality ranging from 1 % to 4 %. These interventions are also associated with high postoperative morbidity and long-term disorders such as diabetes [4] and exocrine insufficiency. Less invasive surgery, including enucleation (EN) and resection of ucinate process (RUP), has been introduced for management of benign IPMN to preserve pancreatic function postoperatively and decrease postoperative mortality and morbidity.

However, recommendations and reports of postoperative complications and clinical outcomes following these procedures have been limited. The debate between PR and EN is still a challenge for surgeons. At our knowledge, this is the first meta-analysis to compare EN to PR for the treatment of side-branch IPMN.This systematic review aimed to determine whether the EN is associated or not with a higher risk of mortality and morbidity compared to PR techniques for side-branch IPMN of the pancreas.

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