title: Pancreatic endocrine tumors less than 4 cm in diameter: resect or enucleate? a single-center experience.
abstract: OBJECTIVE
  Pancreatic endocrine tumors (PETs) are usually small, benign or low-grade malignant, and surgery should preserve the pancreatic parenchyma as much as possible. The aim of the study was to evaluate the postoperative and long-term survival of patients undergoing enucleation in small PETs.
  
  
  METHODS
  Of 82 patients having PETs, 46 with tumor less than 4 cm in diameter, without distant metastases and with R0 resection by final pathologic examination, were included in this study. Enucleation was performed when the tumor did not involve the main pancreatic duct and in the absence of peripancreatic lymphadenopathy (group A); a typical resection was carried out in all other cases (group B). The 2 groups were compared regarding postoperative mortality and morbidity, pancreatic fistula, postoperative hospital stay, reoperation, World Health Organization classification, TNM stage, recurrence, and long-term survival.
  
  
  RESULTS
  There were 15 patients (32.6%) in group A and 31 (67.4%) in group B. Postoperative and long-term results were similar in the 2 groups, whereas World Health Organization classification was significantly different; enucleation was performed more frequently than typical R0 resection in benign tumors (P = 0.009).
  
  
  CONCLUSIONS
  Enucleation should be reserved for patients having benign PETs less than 4 cm in diameter and far from the main pancreatic duct.
authors.affiliation: Dipartimento di Scienze Chirurgiche e Anestesiologiche, Policlinico S. Orsola-Malpighi, Alma Mater Studiorum Università di Bologna, Bologna, Italy. riccardo.casadei@aosp.bo.it
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Daniela
authors.initials: D
authors.lastname: Rega
authors.forename: Marielda
authors.initials: M
authors.lastname: D'Ambra
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
authors.forename: Paola
authors.initials: P
authors.lastname: Tomassetti
authors.forename: Davide
authors.initials: D
authors.lastname: Campana
authors.forename: Francesca
authors.initials: F
authors.lastname: Nori
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018358:Neuroendocrine Tumors / Q000145:classification / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014944:World Health Organization