Laparoscopic versus open enucleation for pancreatic neoplasms: clinical outcomes and pancreatic function analysis.
The studies comparing laparoscopic enucleation (LE) with open enucleation (OE) are limited. This study aimed to compare perioperative outcomes of patients undergoing LE and OE and to assess the pancreatic function after LE.



Between February 2001 and July 2014, patients who underwent enucleation were reviewed. Patients were divided into two groups as LE and OE. Data considered for comparison analysis were patient demographics, intraoperative variables, morbidity, postoperative hospital stay, mortality, pathologic findings, and long-term follow-up (including pancreatic function).



Thirty-seven patients (15 LE and 22 OE) were included in the final analysis. Baseline characteristics were similar in the two groups. LE group showed significantly shorter operating time (118.2 ± 33.1 vs. 155.2 ± 44.3 min, p = 0.009), lower estimated blood loss (80.0 ± 71.2 vs. 195.5 ± 103.4 ml, p = 0.001), shorter first flatus time (1.8 ± 1.0 vs. 3.4 ± 1.8 days, p = 0.004), shorter diet start time (2.4 ± 1.0 vs. 4.4 ± 2.0 days, p = 0.001), shorter postoperative hospital stay (7.9 ± 3.4 vs. 11.2 ± 5.7 days, p = 0.046). Postoperative outcomes, including morbidity (40.0 vs. 45.5 %, p = 1.000), grade B/C pancreatic fistula rates (20.0 vs. 13.6 %, p = 0.874), and mortality, were similar in the two groups. The median follow-up period was 47 months (range 7-163 months). No local recurrence or distant metastasis was detected in either group. Only one patient (4.8 %) underwent OE developed new-onset diabetes, in comparison with none in the LE group. One patient (7.1 %) had weight loss and received pancreatic enzyme supplementation in the LE group, in comparison with two patients (9.5 %) in the OE group.



LE is a safe and feasible technique for the benign or low malignant-potential pancreatic neoplasms. Compared to OE, LE had shorter operating time, lower estimated blood loss, and faster recovery. LE could preserve the pancreatic function as the OE.
Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
Ren-Chao
RC
Zhang
Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
Yu-Cheng
YC
Zhou
Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China. yipingmou@126.com.
Yi-Ping
YP
Mou
Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
Chao-Jie
CJ
Huang
School of Medicine, Zhejiang University, Hangzhou, 310029, Zhejiang Province, China.
Wei-Wei
WW
Jin
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China.
Jia-Fei
JF
Yan
Department of General Surgery, Zhejiang Provincial People's Hospital, Wenzhou Medical University, 158 Shangtang Road, Hangzhou, 310014, Zhejiang Province, China.
Yong-Xiang
YX
Wang
Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China.
Yi
Y
Liao
D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D020127:Recovery of Function
Enucleation; Laparoscopy; Pancreas; Pancreatic function