Related Experiment Video
Updated: Nov 25, 2025
Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head
Published on: January 3, 2020
Small pancreatic neuroendocrine tumors: Resect or enucleate?
Joal D Beane1, Jeffrey D Borrebach2, Andrew Billderback2
1The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Background:
The aim of this analysis is to compare the postoperative outcomes of resection and enucleation of small pancreatic neuroendocrine tumors (PNETs).
Methods:
The 2014-17 American College of Surgeons-NSQIP dataset was queried. Patients undergoing pancreatoduodenectomy (N = 297) or distal pancreatectomy (N = 712) for nonfunctional, small PNETs (T1/T2) were compared to 127 patients (11%) who were enucleated.
Results:
Operative time (170 vs 261, p < 0.01) and transfusions were less in the enucleation cohort (1.6% vs 6.7% p < 0.01). There was no difference in postoperative pancreatic fistulas, but morbidity was lower in enucleated patients (36.2% vs 48.7% p < 0.01). Fifteen resected patients died postoperatively (1.5%) while all enucleated patients survived (p = 0.058). Mean postoperative length of stay was shorter after enucleation (5.7 vs 7.2 days p < 0.01).
Conclusions:
Enucleation of PNETs is performed in only 11% of patients, but takes less time, requires fewer transfusions, and is associated with reduced morbidity and shorter length of stay than resection.
Insights
Enucleation is a less invasive surgical option for small pancreatic neuroendocrine tumors (PNETs), showing reduced operative time, fewer transfusions, and lower morbidity compared to resection.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Endocrinology
Background:
- Small pancreatic neuroendocrine tumors (PNETs) require careful surgical consideration.
- Comparing surgical approaches is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare the postoperative outcomes of resection versus enucleation for small PNETs.
- To evaluate the safety and efficacy of each surgical technique.
Main Methods:
- Analysis of the 2014-2017 American College of Surgeons-NSQIP dataset.
- Comparison of patients undergoing pancreatoduodenectomy or distal pancreatectomy with those who underwent enucleation for small, nonfunctional PNETs (T1/T2).
Main Results:
- Enucleation was associated with significantly shorter operative times (170 vs. 261 minutes) and fewer transfusions (1.6% vs. 6.7%).
- Morbidity was lower in the enucleation group (36.2% vs. 48.7%), with no difference in pancreatic fistulas.
- Postoperative length of stay was shorter after enucleation (5.7 vs. 7.2 days), and mortality was lower (0% vs. 1.5%).
Conclusions:
- Enucleation, though performed in only 11% of cases, offers significant advantages over resection for small PNETs.
- Enucleation leads to reduced operative time, fewer transfusions, decreased morbidity, and shorter hospital stays.
- These findings suggest enucleation as a favorable surgical option for select small PNETs.
