Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 29.
doi: 10.1007/s00464-025-11935-7. Online ahead of print.

Laparoscopic enucleation vs. pancreatectomy for small pancreatic neuroendocrine neoplasms: long-term functional and oncological outcomes

Takayuki Miura  1 , Shuichi Aoki  2 , Shimpei Maeda  2 , Masaharu Ishida  2 , Masamichi Mizuma  2 , Kiyoshi Kume  3 , Keigo Murakami  4 , Atsushi Masamune  3 , Toru Furukawa  4 , Takashi Kamei  2 , Michiaki Unno  2
Affiliations

Laparoscopic enucleation vs. pancreatectomy for small pancreatic neuroendocrine neoplasms: long-term functional and oncological outcomes

Takayuki Miura et al. Surg Endosc. .

Abstract

Background: Laparoscopic surgery is being increasingly used for pancreatic neuroendocrine neoplasms (PanNENs). Although laparoscopic regular pancreatectomy (LRP) is frequently performed, laparoscopic enucleation (LE), a parenchyma-sparing technique, may be better in preserving pancreatic endocrine function. However, limited evidence is available regarding the long-term oncological and endocrine outcomes of these two laparoscopic methods. This study aimed to compare the surgical and prognostic outcomes and endocrine function preservation in patients undergoing LE and LRP for well-differentiated, non-invasive PanNEN.

Methods: This retrospective cohort study included 67 consecutive patients who underwent laparoscopic surgery for small (< 2 cm) well-differentiated PanNEN at Tohoku University Hospital between January 2001 and December 2021. LE was performed for small tumors (< 2 cm) located away (> 3 mm) from the main pancreatic duct. Clinical characteristics, surgical details, tumor characteristics, postoperative complications, recurrence-free survival (RFS), overall survival (OS), and long-term endocrine function were retrospectively analyzed. Kaplan-Meier analysis, Cox regression, and the Mann-Whitney U test were used for statistical comparisons.

Results: The median follow-up was 78.1 months for LRP and 135.4 months for LE. No significant differences were observed between the two groups in terms of the operative time, blood loss, or postoperative complications. Five-year RFS was excellent and comparable in both groups (LE, 100%, LRP 96.0%; P = 0.313). Notably, LE was associated with a significantly reduced incidence of postoperative new-onset diabetes mellitus (NODM) compared to LRP (5-year cumulative incidence: 9.1% vs. 43.2%; P = 0.0181). Multivariate analysis identified LRP (hazard ratio [HR] = 7.71, 95% confidence interval [CI]:1.03-57.8; P = 0.0469), older age (> 60 years) (HR = 4.49, 95% CI 1.62-12.4; P = 0.0039), and non-functional tumor (HR = 2.78, 95% CI 1.08-7.19; P = 0.0342) as independent predictors of NODM.

Conclusion: Given appropriate patient selection, LE of small well-differentiated PanNENs provides comparable oncological outcomes, perioperative safety, and superior long-term endocrine function preservation compared to LRP.

Keywords: Endocrine insufficiency; Laparoscopic enucleation; Laparoscopic regular pancreatectomy; Pancreatic neuroendocrine neoplasms.

PubMed Disclaimer

Conflict of interest statement

Declarations. Disclosures: Drs. Takayuki Miura, Shuichi Aoki, Shimpei Maeda, Masaharu Ishida, Masamichi Mizuma, Kiyoshi Kume, Keigo Murakami, Atsushi Masamune, Toru Furukawa, Takashi Kamei, and Michiaki Unno have no conflicts of interest or financial ties to disclose. Consent for publication: Not applicable.

Similar articles

See all similar articles

References

    1. Dasari A, Shen C, Halperin D, Zhao B, Zhou S, Xu Y, Shih T, Yao JC (2017) Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United States. JAMA Oncol 3:1335–1342. https://doi.org/10.1001/jamaoncol.2017.0589 - DOI - PubMed - PMC
    1. Kos-Kudla B, Castaño JP, Denecke T, Grande E, Kjaer A, Koumarianou A, de Mestier L, Partelli S, Perren A, Stattner S, Valle JW, Fazio N (2023) European Neuroendocrine Tumour Society (ENETS) 2023 guidance paper for nonfunctioning pancreatic neuroendocrine tumours. J Neuroendocrinol 35:e13343. https://doi.org/10.1111/jne.13343 - DOI - PubMed
    1. Yang Z, Gao H, Lu J, Niu Z, Zhu H, Zong Y, Song X, Yang F, Zhou X (2021) Comparison of clinical outcomes between enucleation and regular pancreatectomy in patients with non-functional pancreatic neuroendocrine tumors: a retrospective multicenter and propensity score-matched study. Jpn J Clin Oncol 51:595–603. https://doi.org/10.1093/jjco/hyaa246 - DOI - PubMed
    1. Shen X, Yang X (2022) Comparison of outcomes of enucleation vs. standard surgical resection for pancreatic neoplasms: a systematic review and meta-analysis. Front Surg 8:744316. https://doi.org/10.3389/fsurg.2021.744316 - DOI - PubMed - PMC
    1. Zhou Y, Zhao M, Wu L, Ye F, Si X (2016) Short- and long-term outcomes after enucleation of pancreatic tumors: an evidence-based assessment. Pancreatology 16:1092–1098. https://doi.org/10.1016/j.pan.2016.07.006 - DOI - PubMed

LinkOut - more resources