Laparoscopic enucleation of tumors embedded in the pancreatic head: Safety and feasibility

Abstract

Summary: Background: Surgical treatment for a benign or low-grade malignant tumor in the pancreatic head remains a challenge at present. As an organ-sparing procedure, enucleation is ideal. However, it is still controversial whether laparoscopic enucleation (LapEN) can be safely performed for a pancreatic head tumor, especially a deeply embedded one. Methods: The cases who underwent LapEN of a pancreatic tumor from January 2014 to September 2022 in our hospital were collected and analyzed. Results: A total of 151 cases were collected. The incidence of pancreatic fistula (PF, grade B) was 21.9 %. No patient developed PF (grade C) or died. Compared with enucleating a tumor in the distal pancreas (N = 98), enucleating a tumor in the pancreatic head (N = 53) showed a longer operation time and a higher incidence of conversion. The cases with a tumor in the pancreatic head were then divided into the group with a deeply embedded tumor (N = 32) and the group with a superficial tumor (N = 21). The embedded group had a smaller tumor size and a higher proportion of insulinoma. There were no statistical differences in the parameters of operation time, blood loss and incidence of complications between the two groups. The outcomes of enucleating a tumor deeply embedded in the proximal and distal pancreas were further analyzed, which indicated no statistical differences in clinical parameters between the two groups. Conclusion: LapEN of a tumor in the pancreatic head is feasible and safe, even for a deeply embedded tumor.

Keywords

• Laparoscopic enucleation
• Organ-sparing procedure
• Pancreatic tumor
• Pancreatic fistula