Miura Takayuki, Aoki Shuichi, Maeda Shimpei, Ishida Masaharu, Mizuma Masamichi, Kume Kiyoshi, Murakami Keigo, Masamune Atsushi, Furukawa Toru, Kamei Takashi, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Department of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Surg Endosc. 2025 Aug 29. doi: 10.1007/s00464-025-11935-7.
Laparoscopic surgery is being increasingly used for pancreatic neuroendocrine neoplasms (PanNENs). Although laparoscopic regular pancreatectomy (LRP) is frequently performed, laparoscopic enucleation (LE), a parenchyma-sparing technique, may be better in preserving pancreatic endocrine function. However, limited evidence is available regarding the long-term oncological and endocrine outcomes of these two laparoscopic methods. This study aimed to compare the surgical and prognostic outcomes and endocrine function preservation in patients undergoing LE and LRP for well-differentiated, non-invasive PanNEN.
This retrospective cohort study included 67 consecutive patients who underwent laparoscopic surgery for small (< 2 cm) well-differentiated PanNEN at Tohoku University Hospital between January 2001 and December 2021. LE was performed for small tumors (< 2 cm) located away (> 3 mm) from the main pancreatic duct. Clinical characteristics, surgical details, tumor characteristics, postoperative complications, recurrence-free survival (RFS), overall survival (OS), and long-term endocrine function were retrospectively analyzed. Kaplan-Meier analysis, Cox regression, and the Mann-Whitney U test were used for statistical comparisons.
The median follow-up was 78.1 months for LRP and 135.4 months for LE. No significant differences were observed between the two groups in terms of the operative time, blood loss, or postoperative complications. Five-year RFS was excellent and comparable in both groups (LE, 100%, LRP 96.0%; P = 0.313). Notably, LE was associated with a significantly reduced incidence of postoperative new-onset diabetes mellitus (NODM) compared to LRP (5-year cumulative incidence: 9.1% vs. 43.2%; P = 0.0181). Multivariate analysis identified LRP (hazard ratio [HR] = 7.71, 95% confidence interval [CI]:1.03-57.8; P = 0.0469), older age (> 60 years) (HR = 4.49, 95% CI 1.62-12.4; P = 0.0039), and non-functional tumor (HR = 2.78, 95% CI 1.08-7.19; P = 0.0342) as independent predictors of NODM.
Given appropriate patient selection, LE of small well-differentiated PanNENs provides comparable oncological outcomes, perioperative safety, and superior long-term endocrine function preservation compared to LRP.
腹腔镜手术在胰腺神经内分泌肿瘤（PanNENs）中的应用越来越广泛。虽然腹腔镜规则性胰腺切除术（LRP）经常被实施，但腹腔镜剜除术（LE）作为一种保留实质的技术，在保留胰腺内分泌功能方面可能更具优势。然而，关于这两种腹腔镜手术方法的长期肿瘤学和内分泌学结局的证据有限。本研究旨在比较接受LE和LRP治疗的高分化、非侵袭性PanNEN患者的手术和预后结局以及内分泌功能的保留情况。
这项回顾性队列研究纳入了2001年1月至2021年12月在东北大学医院接受腹腔镜手术治疗小（<2 cm）高分化PanNEN的67例连续患者。对于距离主胰管较远（>3 mm）的小肿瘤（<2 cm）实施LE。对临床特征、手术细节、肿瘤特征、术后并发症、无复发生存期（RFS）、总生存期（OS）和长期内分泌功能进行回顾性分析。采用Kaplan-Meier分析、Cox回归和Mann-Whitney U检验进行统计学比较。
LRP组的中位随访时间为78.1个月，LE组为135.4个月。两组在手术时间、失血量或术后并发症方面未观察到显著差异。两组的5年RFS均良好且相当（LE组为100%，LRP组为96.0%；P = 0.313）。值得注意的是，与LRP相比，LE术后新发糖尿病（NODM）的发生率显著降低（5年累积发生率：9.1%对43.2%；P = 0.0181）。多因素分析确定LRP（风险比[HR]=7.71，95%置信区间[CI]：1.03 - 57.8；P = 0.0469）、年龄较大（>60岁）（HR = 4.49，95% CI 1.62 - 12.4；P = 0.0039）和无功能肿瘤（HR = 2.78，95% CI 1.08 - 7.19；P = 0.0342）是NODM的独立预测因素。
在合适的患者选择下，与LRP相比，小的高分化PanNENs的LE具有相当的肿瘤学结局、围手术期安全性和更好的长期内分泌功能保留。
