Role of laparoscopic enucleation in the treatment of pancreatic lesions: case series and case-matched analysis.
Previous studies report successful application of laparoscopic pancreatic enucleation (LPE). However, the evidence is limited to small series. This study aimed to evaluate the indications, technique and outcome of LPE at a tertiary care institution.



Between February 1998 and April 2016, 45 consecutive LPEs were performed at Oslo University Hospital-Rikshospitalet. Twenty-four (53.3 %) patients subjected to right-sided LPE (RLPE) were compared with 21 (46.7 %) patients who had undergone left-sided LPE (LLPE). A case-matched analysis (1:2) was performed to compare the outcomes following LLPE and laparoscopic distal pancreatectomy (LDP).



Patient demographics, BMI, ASA score and pathological characteristics were similar between the RLPE and LLPE groups. Operative time was slightly longer for RLPE [123 (53-320) vs 102 (50-373) min, P = 0.09]. The rates of severe morbidity (≥Accordion grade III) and clinically relevant pancreatic fistula (grades B/C) were comparable, although with a trend for higher rate of complications following LLPE (16.7 vs 33.3 %; P = 0.19 and 20.8 vs 33.3 %, P = 0.34, respectively). The hospital stay was similar between RLPE and LLPE [5 (2-80) vs 7 (2-52), P = 0.49]. A case-matched analysis demonstrated shorter operating time [145 (90-350) vs 103 (50-233) min, P = 0.02], but higher readmission rate following LLPE (25 vs 3.1 %, P = 0.037).



LLPE seems to be associated with a higher risk of postoperative morbidity and readmission rates than LDP. RLPE is a feasible, safe approach and a reasonable alternative to pancreatoduodenectomy in selected patients with pancreatic lesions.
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway. sahakyan.mushegh@gmail.com.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway. sahakyan.mushegh@gmail.com.|Department of Surgery No 1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia. sahakyan.mushegh@gmail.com.
Mushegh A
MA
Sahakyan
Department of HPB Sugery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Bård Ingvald
BI
Røsok
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway.
Airazat M
AM
Kazaryan
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
Leonid
L
Barkhatov
Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Surgery, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
Sven-Petter
SP
Haugvik
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway.
Åsmund Avdem
ÅA
Fretland
Department of Digestive Surgery, Akershus University Hospital, University of Oslo, Lørenskog, Norway.
Dejan
D
Ignjatovic
Department of HPB Sugery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Knut Jørgen
KJ
Labori
The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.|Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.|Department of HPB Sugery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Bjørn
B
Edwin
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery*
Enucleation; Laparoscopy; Morbidity; Pancreatectomy; Pancreatic fistula