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Multicenter Study
. 2025 Mar;39(3):1696-1708.
doi: 10.1007/s00464-024-11453-y. Epub 2025 Jan 13.

Laparoscopic pancreatic enucleation: how far should we go for parenchyma preservation? A study by the French National Association of Surgery

Clément Pastier  1   2 , Charles De Ponthaud  1   2 , Alexandra Nassar  3 , Olivier Soubrane  4 , Alessandro D Mazzotta  4 , François-Régis Souche  5 , Laurent Brunaud  6 , Reza Kianmanesh  7 , Laurent Sulpice  8 , Lilian Schwarz  9 , Elias Karam  10 , Emilie Lermite  11 , Safi Dokmak  12 , David Fuks  3 , Sébastien Gaujoux  13   14
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Free article
Multicenter Study

Laparoscopic pancreatic enucleation: how far should we go for parenchyma preservation? A study by the French National Association of Surgery

Clément Pastier et al. Surg Endosc. 2025 Mar.
Free article

Abstract

Background: Pancreatic enucleation is indicated for selected patients and tumours with very low oncological risk to preserve a maximum of healthy pancreatic parenchyma. Minimally invasive pancreatic enucleation (MIPE) is increasingly performed. This study aims to assess the impact of tumor location and center experience on textbook outcomes (TBO) in patients undergoing MIPE.

Methods: Retrospective nationwide multicentric cohort study including MIPE performed between 2010 and 2021. Tumor localization was classified as head/uncus, neck or body/tail (results are presented in this order). Centers were classified according to a mean volume of MI pancreatectomies performed per year: lower (< 5/year), intermediate (5 to 10/year) and higher volume (≥ 10/year). TBO was defined as meeting all 6 criteria: no postoperative pancreatic fistula (POPF), no post-pancreatectomy haemorrhage (PPH), no bile leak, no readmission, no mortality, and no severe morbidity.

Results: 27 participating centers performed 200 MIPE located in head/uncus (n = 65, 33%), neck (n = 26, 13%) and body/tail (n = 109, 55%), 8% of them performed by robotic approach. Mortality reached 1.5% (n = 3). Head/uncus lesions were larger (p = 0.03), frequently BD-IPMN (p = 0.04), with significant longer operative time (p = 0.002). TBO achievement was high across all tumor locations (52 vs. 73 vs. 67%, p = 0.09) with higher PPH (p = 0.03) or bile leaks (p = 0.03) for head/uncus lesions. In multivariate analysis, overweight (OR 0.49), preoperative biopsy (OR 0.41) and head/uncus lesion (OR 0.34) were independently associated with lower TBO. No independent risk factor was found for POPF or severe morbidity. While expertise level influenced indications, with more cystic lesions (p = 0.002), larger tumors (p = 0.003), 3D use (p = 0.001), and head/uncus lesions (p = 0.04) in high volume centers, TBO was not significantly different (p = 0.45).

Conclusions: MIPE is feasible with 1.5% mortality whatever its localization with higher morbidity for head/uncus lesions, justified by the will to avoid pancreaticoduodenectomy. High volume centers push the limits of MIPE without increasing morbidity.

Keywords: Anatomical classification; Enucleation; Mini-invasive surgery; Pancreatectomy; Parenchyma-sparing surgery.

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Conflict of interest statement

Declarations. Disclosure: Clément Pastier, Charles De Ponthaud, Alexandra Nassar, Olivier Soubrane, Alessandro D Mazzotta, François-Régis Souche, Laurent Brunaud, Reza Kianmanesh, Laurent Sulpice, Lilian Schwarz, Elias Karam, Emilie Lermite, Safi Dokmak, David Fuks, and Sébastien Gaujoux have no conflicts of interest or financial ties to disclose.

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