A pancreatic enucleation procedure is an operation designed to remove small (<2 cm), benign tumors of the pancreas. This procedure involves shelling out the tumor from the surrounding pancreas. For enucleation to be performed safely, the lesion should be at least 2-3 mm distant from the main pancreatic duct and not too deep in the parenchyma. If the lesion is too close to a duct, the risk of inadvertent ductal damage is substantial, and may result in a particularly hard to treat pancreatic fistula. Therefore, the distance between the tumor and the main pancreatic duct should be assessed preoperatively by means of magnetic resonance imaging with cholangio-pancreatography. Intra-operative ultrasound should be also performed to confirm the relationship between the neoplasm and the main pancreatic. Moreover, it allows clear identification of the lesion, and evaluation of its morphology and site.

The incidence of postoperative complications, particularly pancreatic fistula, is high, despite the majority of fistulas have an indolent course. The main advantage of enucleation is the preservation of almost all the pancreatic parenchyma, thereby minimizing the risk of long-term exocrine and endocrine insufficiency.

Enucleation can be performed using a minimally invasive approach. For more information click here.