Abstract
BACKGROUND: The optimal surgical approach for large benign or low-grade malignant pancreatic tumors is controversial. The objective of this study was to evaluate the safety and feasibility of laparoscopic enucleation (LapEN) for large pancreatic tumors (≥4 cm). METHODS: Patients who met the inclusion criteria at Qilu Hospital of Shandong University from January 2015 to May 2022 were retrospectively analyzed. First, the safety and feasibility of LapEN procedure were evaluated based on tumor diameter (≥4 cm or not). And then, we further compared the efficacy between LapEN and standard pancreatectomy [laparoscopic pancreaticoduodenectomy (LPD)/ laparoscopic distal pancreatectomy (LDP)] in patients with large tumors (≥4 cm). RESULTS: Compared with patients with small tumors who underwent LapEN, there was no significant difference in rates of perioperative adverse events and postoperative complications in patients with large tumors who underwent LapEN, only postoperative hospital stays were prolonged. Among patients with large pancreatic tumors, comparison with standard pancreatectomy, LapEN achieved shorter operative time [(LapEN vs. LPD: 160.0 ± 41.4vs 396.8 ± 92.4 min, p < 0.001); (LapEN vs. LDP: 132.5 ± 53.0 vs. 223.1 ± 67.7 min, p < 0.001)] and less blood loss {[LapEN vs. LPD: 50 mL (range, 10-400 mL) vs. 300 mL (range, 50-1,000 mL), p < 0.001]; [LapEN vs. LDP: 40 mL (range, 5-300 mL) vs. 150 mL (range, 20-1,000 mL), p = 0.001]}. Particularly for large pancreatic head tumors, LapEN was superior to LPD in other terms of conversion rate, postoperative hospital stays, duration of fasting, pain score, and red blood cell transfusion rate. CONCLUSION: LapEN is a safe and feasible treatment option for large benign or low-grade malignant pancreatic tumors.