title: Pancreatic enucleation: improved outcomes compared to resection.
abstract: BACKGROUND
  Pancreatic enucleation is associated with a low operative mortality and preserved pancreatic parenchyma. However, enucleation is an uncommon operation, and good comparative data with resection are lacking. Therefore, the aim of this analysis was to compare the outcomes of pancreatic enucleation and resection.
  
  
  METHODS
  From 1998 through 2010, 45 consecutive patients with small (mean, 2.3 cm) pancreatic lesions underwent enucleation. These patients were matched with 90 patients undergoing pancreatoduodenectomy (n = 38) or distal pancreatectomy (n = 52). Serious morbidity was defined in accordance with the American College of Surgeons-National Surgical Quality Improvement Program. Outcomes were compared with standard statistical analyses.
  
  
  RESULTS
  Operative time was shorter (183 vs. 271 min, p < 0.01), and operative blood loss was significantly lower (160 vs. 691 ml, p < 0.01) with enucleation. Fewer patients undergoing enucleation required monitoring in an intensive care unit (20% vs. 41%, p < 0.02). Serious morbidity was less common among patients who underwent enucleation compared to those who had a resection (13% vs. 29%, p = 0.05). Pancreatic endocrine (4% vs. 17%, p = 0.05) and exocrine (2% vs. 17%, p < 0.05) insufficiency were less common with enucleation. Ten-year survival was no different between enucleation and resection.
  
  
  CONCLUSIONS
  Compared to resection, pancreatic enucleation is associated with improved operative as well as short- and long-term postoperative outcomes. For small benign and premalignant pancreatic lesions, enucleation should be considered the procedure of choice when technically appropriate.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 535 Barnhill Drive, RT 130D, Indianapolis, IN, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Cauley
authors.forename: H A
authors.initials: HA
authors.lastname: Pitt
authors.forename: K M
authors.initials: KM
authors.lastname: Ziegler
authors.forename: A
authors.initials: A
authors.lastname: Nakeeb
authors.forename: C M
authors.initials: CM
authors.lastname: Schmidt
authors.forename: N J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: M G
authors.initials: MG
authors.lastname: House
authors.forename: K D
authors.initials: KD
authors.lastname: Lillemoe
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000601:surgery*; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000401:mortality; D010181:Pancreatic Cyst / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome