Enucleation for pancreatic neuroendocrine tumors: short- and long-term outcomes in a forty-year single-center experience.

BackgroundSurgery plays a key role in the treatment of pancreatic neuroendocrine tumors (PanNETs). Enucleation combines a radical resection with the sparing of healthy pancreatic parenchyma.MethodsTo evaluate short- and long-term outcomes of open enucleation for PanNETs, clinical records of patients operated on from 1979 to 2021 in our Pancreatic Surgical Unit were retrieved retrospectively.ResultsOut of 246 PanNETs operated on, 62 (25%) patients underwent enucleation: 39 (63%) women and 23 (37%) men, averaging a mean of 55 (SD, 14) years. Pancreatic NETs were mostly insulinomas (65%), located in the head/uncinate process (61%), and grade 1 (55%), with a median size of 1.5 (IQR, 1.0-1.8) cm. Median operation time was 180 (IQR, 150-205) minutes, and median intraoperative blood loss was 100 (IQR, 20-200) mL. Pancreatic fistula (all grade B) occurred in ten (16%) patients. One (1.6%) reoperation was required for evisceration. Median hospital stay was 10 (IQR, 7-15) days. There was no postoperative mortality. Median follow-up was 153 (IQR, 91-278) months, with seven (11%) patients developing new onset diabetes; however, no exocrine insufficiency occurred. Fourteen (23%) patients died of unrelated causes after a mean overall survival of 219 (SD, 152) months.ConclusionsEnucleation of PanNETs resulted in excellent long-term results for both pancreatic function and oncological outcomes. In open surgery, postoperative morbidity is not negligible, but it does not affect patients' prognosis.