Reappraisal of pancreatic enucleations: A single-center experience of 126 procedures

• Published in: Surgery 2015-07, Vol.158 (1), p.201-210
• Main Authors: Faitot, Francois, MD, Gaujoux, Sébastien, MD, PhD, Barbier, Louise, MD, Novaes, Marleny, MD, Dokmak, Safi, MD, Aussilhou, Béatrice, MD, Couvelard, Anne, MD, PhD, Rebours, Vinciane, MD, PhD, Ruszniewski, Philippe, MD, Belghiti, Jacques, MD, Sauvanet, Alain, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Female; Humans; Male; Middle Aged; Pancreas - surgery; Pancreatectomy - methods; Pancreatic Neoplasms - surgery; Retrospective Studies; Surgery; Young Adult
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2015.03.023

Background Parenchyma-sparing pancreatectomies, especially enucleations, could avoid disappointing functional results associated with standard resections for benign/low-grade pancreatic neoplasms. This study aimed to assess short- and long-term outcomes in a large, single-center series of enucleations. Methods All 126 patients who underwent enucleation for benign/low-grade neoplasms between 1996 and 2011 were included retrospectively. Results Lesions were mainly incidentally diagnosed (71%), most often located in the head (46%), and with a median size of 20 mm. Enucleations were mainly performed for branch-duct intraductal papillary mucinous neoplasm (30%), nonfunctioning pancreatic neuroendocrine tumors (29%), and mucinous cystadenoma (21%). Overall mortality was 0.8% and morbidity 63%, mainly owing to pancreatic fistula (57%). Most were significant clinically, that is, grade B or C (41%), but managed conservatively (85%). Reoperation rate was 3%, mainly owing to hemorrhage. Postoperative de novo diabetes was 0.8%, and exocrine insufficiency never observed. The 1-, 3-, and 5-year recurrence-free survival were 100%, 98%, and 93%, respectively. Conclusion Enucleation is associated with substantial morbidity, especially pancreatic fistula. Enucleations as an alternative to standard resection are best indicated for small, benign, and low-grade lesions located far from the main pancreatic duct. Enucleations should be proposed to young and fit patients able to tolerate postoperative morbidity and who could benefit from the excellent long-term results.