Abstract / Summary
The rising incidental detection of benign and low-grade malignant pancreatic tumors has driven a shift toward parenchyma-sparing laparoscopic local pancreatectomy (LLP). However, real-world evidence on laparoscopic pancreatic enucleation (LPEn) for lesions in close proximity to the main pancreatic duct (MPD) remains limited. We retrospectively analyzed 64 consecutive patients undergoing LPEn for benign and low-grade malignant pancreatic tumors between January 2021 and October 2025 at a single high-volume center. Demographics, operative details, perioperative outcomes, and pathological characteristics were extracted from a prospectively maintained database. The mean patient age was 51.5 ± 14.2 years, with median tumor size 25.0 mm (IQR 15.0–36.0) and a median tumor-to-MPD distance of 1.7 mm (IQR 0.83–2.6); 31.3% of lesions were located less than 1 mm from the MPD. Laparoscopic completion was achieved in 62 of 64 patients (96.9%). Two patients (3.1%) required conversion to open surgery for inadequate lesion exposure, and there was no mortality. Median operative time was 127.5 min (IQR 90.0–180.0) with median estimated blood loss of 20.0 mL (IQR 20.0–50.0). Clinically relevant postoperative pancreatic fistula (CR-POPF, ISGPS Grade B/C) was reported in 56.3% of cases. The overall postoperative morbidity within 90 days was 59.4% (38/64), and no patient developed Clavien-Dindo grade ≥ IIIb complications. No patient developed new-onset insulin-dependent diabetes or clinically significant exocrine insufficiency during 6-month follow-up. In this single-center series, LPEn for selected lesions in close proximity to the MPD was feasible, with zero mortality, no Clavien-Dindo grade ≥ IIIb morbidity, and preserved endocrine and exocrine function at 6-month follow-up, at the cost of a high rate of CR-POPF. Because MPD stents were placed selectively at the attending surgeon's discretion rather than by protocol, this study cannot establish a protective effect of stenting on fistula severity or procedural safety. The role of selective stenting warrants prospective, protocol-based evaluation.