Abstract: Objective: The aim of this study was to evaluate the safety and efficiency of enucleation (EU) for proximal pancreatic non-invasive neoplasms. Methods: Patients with solitary non-invasive neoplasms in the proximal pancreas from January 1998 to April 2014 at the Second Affiliated Hospital of Zhejiang University, Hangzhou, China were included. Different operations and outcomes were analyzed. Results: A total of 123 patients were enrolled. Forty patients (32.5%) underwent EU including 18 patients who had tumors close to the main pancreatic duct (MPD). Sixty-one patients (49.6%) had pancreaticoduodenectomy (PD) performed and 22 (17.9%) underwent central pancreatectomy (CP). Pathological outcomes included neuroendocrine tumors, cystic lesions, and solid pseudopapillary tumors. Operation time, intra-operative blood loss, and duration of hospital stay were significantly reduced in the EU group. PD was associated with the greatest complication rate (55.7%), followed by EU (50%) and CP (40.9%), though the pancreatic fistula rate after EU was the highest (50%), especially in patients with tumors larger than 3 cm and tumors close to the MPD. EU had advantages in the preservation of pancreatic parenchyma and endocrine and exocrine function. Conclusions: EU can be carried out safely and effectively for tumors in the proximal pancreas with improved outcomes compared with standard resections, even if the tumor is larger than 3 cm and close to the MPD.

近端胰腺非侵袭性肿瘤剜除手术：指征及与传统标准切除手术效果比较

[1]Atema, J.J., Jilesen, A.P., Busch, O.R., et al., 2015. Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions. HPB, 17(1):38-45.

[2]Bassi, C., Dervenis, C., Butturini, G., et al., 2005. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 138(1):8-13.

[3]Beger, H.G., Poch, B., Vasilescu, C., 2014. Benign cystic neoplasm and endocrine tumours of the pancreas—when and how to operate—an overview. Int. J. Surg., 12(6):606-614.

[4]Brient, C., Regenet, N., Sulpice, L., et al., 2012. Risk factors for postoperative pancreatic fistulization subsequent to enucleation. J. Gastrointest. Surg., 16(10):1883-1887.

[5]Butte, J.M., Brennan, M.F., Gönen, M., et al., 2011. Solid pseudopapillary tumors of the pancreas. Clinical features, surgical outcomes, and long-term survival in 45 consecutive patients from a single center. J. Gastrointest. Surg., 15(2):350-357.

[6]Casadei, R., Ricci, C., Rega, D., et al., 2010. Pancreatic endocrine tumors less than 4 cm in diameter: resect or enucleate? A single-center experience. Pancreas, 39(6):825-828.

[7]Cauley, C.E., Pitt, H.A., Ziegler, K.M., et al., 2012. Pancreatic enucleation: improved outcomes compared to resection. J. Gastrointest. Surg., 16(7):1347-1353.

[8]Crippa, S., Bassi, C., Salvia, R., et al., 2007. Enucleation of pancreatic neoplasms. Br. J. Surg., 94(10):1254-1259.

[9]Crippa, S., Boninsegna, L., Partelli, S., et al., 2010. Parenchyma-sparing resections for pancreatic neoplasms. J. Hepatobiliary Pancreat. Sci., 17(6):782-787.

[10]Dong, X., Gao, S.L., Xie, Q.P., et al., 2008. In situ high-volume modified continuous closed and/or open lavage for infected necrotizing pancreatitis. Pancreas, 36(1):44-49.

[11]Falconi, M., Zerbi, A., Crippa, S., et al., 2010. Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors. Ann. Surg. Oncol., 17(6):1621-1627.

[12]Ferrone, C.R., Tang, L.H., Tomlinson, J., et al., 2007. Determining prognosis in patients with pancreatic endocrine neoplasms: can the WHO classification system be simplified? J. Clin. Oncol., 25(35):5609-5615.

[13]Ge, C., Luo, X., Chen, X., et al., 2010. Enucleation of pancreatic cystadenomas. J. Gastrointest. Surg., 14(1):141-147.

[14]Ghaneh, P., Neoptolemos, J.P., 1999. Exocrine pancreatic function following pancreatectomy. Ann. N. Y. Acad. Sci., 880:308-318.

[15]Goasguen, N., Bourrier, A., Ponsot, P., et al., 2009. Endoscopic management of pancreatic fistula after distal pancreatectomy and enucleation. Am. J. Surg., 197(6):715-720.

[16]Grobmyer, S.R., Pieracci, F.M., Allen, P.J., et al., 2007. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J. Am. Coll. Surg., 204(3):356-364.

[17]Hackert, T., Hinz, U., Fritz, S., et al., 2011. Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbeck’s Arch. Surg., 396(8):1197-1203.

[18]Heeger, K., Falconi, M., Partelli, S., et al., 2014. Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbeck’s Arch. Surg., 399(3):315-321.

[19]Ho, V., Heslin, M.J., 2003. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann. Surg., 237(4):509-514.

[20]Howard, J.M., Hess, W., 2002. History of the Pancreas: Mystery of a Hidden Organ. Kluwer Academic/Plenum Publisher, New York.

[21]Inchauste, S.M., Lanier, B.J., Libutti, S.K., et al., 2012. Rate of clinically significant postoperative pancreatic fistula in pancreatic neuroendocrine tumors. World J. Surg., 36(7):1517-1526.

[22]Kiely, J.M., Nakeeb, A., Komorowski, R.A., et al., 2003. Cystic pancreatic neoplasms: enucleate or resect? J. Gastrointest. Surg., 7(7):890-897.

[23]Kulke, M.H., Benson, A.B.3rd, Bergsland, E., et al., 2012. Neuroendocrine tumors. J. Natl. Compr. Canc. Netw., 10(6):724-764.

[24]le Borgne, J., de Calan, L., Partensky, C., 1999. Cystadenomas and cystadenocarcinomas of the pancreas: a multiinstitutional retrospective study of 398 cases. French Surgical Association. Ann. Surg., 230(2):152-161.

[25]Lu, W.J., Xu, B., Gao, S.L., et al., 2012. Enucleation of benign or borderline pancreatic head tumors adjacent to the common pancreatic duct. Pancreas, 41(2):336-337.

[26]Madan, A.K., Weldon, C.B., Long, W.P., et al., 2004. Solid and papillary epithelial neoplasm of the pancreas. J. Surg. Oncol., 85(4):193-198.

[27]Norton, J.A., 2006. Surgery for primary pancreatic neuroendocrine tumors. J. Gastrointest. Surg., 10(3):327-331.

[28]Papavramidis, T., Papavramidis, S., 2005. Solid pseudopapillary tumors of the pancreas: review of 718 patients reported in English literature. J. Am. Coll. Surg., 200(6):965-972.

[29]Pitt, S.C., Pitt, H.A., Baker, M.S., et al., 2009. Small pancreatic and periampullary neuroendocrine tumors: resect or enucleate? J. Gastrointest. Surg., 13(9):1692-1698.

[30]Ramage, J.K., Davies, A.H., Ardill, J., et al., 2005. Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut, 54:iv1-iv16.

[31]Reid-Lombardo, K.M., Ramos-de la Medin, A., Thomsen, K., et al., 2007. Long-term anastomotic complications after pancreaticoduodenectomy for benign diseases. J. Gastrointest. Surg., 11(12):1704-1711.

[32]Schmidt, C.M., White, P.B., Waters, J.A., et al., 2007. Intraductal papillary mucinous neoplasms: predictors of malignant and invasive pathology. Ann. Surg., 246(4):644-654.

[33]Sciaudone, G., Perniceni, T., Lévy, P., et al., 2000. Enucleation of intraductal papillary-mucinous tumor of the head of the pancreas. Report of 2 cases. Gastroenterol. Clin. Biol., 24(1):121-124 (in French).

[34]Talamini, M.A., Moesinger, R., Yeo, C.J., et al., 1998. Cystadenomas of the pancreas: is enucleation an adequate operation? Ann. Surg., 227(6):896-903.

[35]Tran, T.C., van Lanschot, J.J., Bruno, M.J., et al., 2009. Functional changes after pancreatoduodenectomy: diagnosis and treatment. Pancreatology, 9(6):729-737.

[36]Turrini, O., Schmidt, C.M., Pitt, H.A., et al., 2011. Side-branch intraductal papillary mucinous neoplasms of the pancreatic head/uncinate: resection or enucleation? HPB, 13(2):126-131.

[37]Valsangkar, N.P., Morales-Oyarvide, V., Thayer, S.P., et al., 2012. 851 resected cystic tumors of the pancreas: a 33-year experience at the Massachusetts General Hospital. Surgery, 152(3 Suppl.):S4-S12.

[38]Wente, M.N., Veit, J.A., Bassi, C., et al., 2007a. Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 142(1):20-25.

[39]Wente, M.N., Bassi, C., Dervenis, C., et al., 2007b. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 142(5):761-768.

[40]Yan, J.F., Kuang, T.T., Ji, D.Y., et al., 2015. Laparoscopic versus open distal pancreatectomy for benign or premalignant pancreatic neoplasms: a two-center comparative study. J. Zhejiang Univ.-Sci. B (Biomed. & Biotechnol.), 16(7):573-579.

[41]Zhang, T., Xu, J., Wang, T., et al., 2013. Enucleation of pancreatic lesions: indications, outcomes, and risk factors for clinical pancreatic fistula. J. Gastrointest. Surg., 17(12):2099-2104.