Evidence map›Paper›PMID 39806174›Full record

ArticleSurgical endoscopy2025

Laparoscopic pancreatic enucleation: how far should we go for parenchyma preservation? A study by the French National Association of Surgery.

Clément Pastier, Charles De Ponthaud, Alexandra Nassar, Olivier Soubrane, Alessandro D Mazzotta, François-Régis Souche, Laurent Brunaud, Reza Kianmanesh, Laurent Sulpice, Lilian Schwarz and 5 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Clément PastierDepartment of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.ORCID 0000-0002-7736-3999
Charles De PonthaudDepartment of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
Alexandra NassarDepartment of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, APHP, Cochin Hospital, Paris, France.
Olivier SoubraneDepartment of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France.
Alessandro D MazzottaDepartment of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Paris, France.
François-Régis SoucheDepartment of Surgery, Hopital Saint Eloi, Montpellier, France.
Laurent BrunaudUnit of Endocrine and Metabolic Surgery, Department of Surgery, CHU Nancy-Hospital Brabois Adultes, University of Lorraine, Nancy, France.
Reza KianmaneshDepartment of HBP and Digestive Oncological Surgery, Robert Debré University Hospital, University Reims Champagne, Ardenne, France.
Laurent SulpiceDepartment of Hepatobiliary and Digestive Surgery, Pontchaillou Hospital, CHU Rennes, France.
Lilian SchwarzDepartment of Digestive Surgery, Rouen University Hospital and Université de Rouen Normandie, Rouen, France.
Elias KaramDepartment of Visceral Surgery, Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Tours University Hospital, Tours, France.
Emilie LermiteService de Chirurgie Digestive, University Hospital of Angers, Angers, France.
Safi DokmakDepartment of HPB Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, University of Paris Cité, Centre de Recherche Sur L'Inflammation, INSERM Unité Mixte de Recherche 1149, Clichy, France.
David FuksDepartment of Digestive, Pancreatic, Hepatobiliary and Endocrine Surgery, APHP, Cochin Hospital, Paris, France.
Sébastien GaujouxDepartment of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP, Pitié-Salpêtrière Hospital, Paris, France. sebastien.gaujoux@aphp.fr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPancreatic enucleation is indicated for selected patients and tumours with very low oncological risk to preserve a maximum of healthy pancreatic parenchyma. Minimally invasive pancreatic enucleation (MIPE) is increasingly performed. This study aims to assess the impact of tumor location and center experience on textbook outcomes (TBO) in patients undergoing MIPE.

methodsRetrospective nationwide multicentric cohort study including MIPE performed between 2010 and 2021. Tumor localization was classified as head/uncus, neck or body/tail (results are presented in this order). Centers were classified according to a mean volume of MI pancreatectomies performed per year: lower (< 5/year), intermediate (5 to 10/year) and higher volume (≥ 10/year). TBO was defined as meeting all 6 criteria: no postoperative pancreatic fistula (POPF), no post-pancreatectomy haemorrhage (PPH), no bile leak, no readmission, no mortality, and no severe morbidity.

results27 participating centers performed 200 MIPE located in head/uncus (n = 65, 33%), neck (n = 26, 13%) and body/tail (n = 109, 55%), 8% of them performed by robotic approach. Mortality reached 1.5% (n = 3). Head/uncus lesions were larger (p = 0.03), frequently BD-IPMN (p = 0.04), with significant longer operative time (p = 0.002). TBO achievement was high across all tumor locations (52 vs. 73 vs. 67%, p = 0.09) with higher PPH (p = 0.03) or bile leaks (p = 0.03) for head/uncus lesions. In multivariate analysis, overweight (OR 0.49), preoperative biopsy (OR 0.41) and head/uncus lesion (OR 0.34) were independently associated with lower TBO. No independent risk factor was found for POPF or severe morbidity. While expertise level influenced indications, with more cystic lesions (p = 0.002), larger tumors (p = 0.003), 3D use (p = 0.001), and head/uncus lesions (p = 0.04) in high volume centers, TBO was not significantly different (p = 0.45).

conclusionsMIPE is feasible with 1.5% mortality whatever its localization with higher morbidity for head/uncus lesions, justified by the will to avoid pancreaticoduodenectomy. High volume centers push the limits of MIPE without increasing morbidity.

Indexed as

LaparoscopyOrgan Sparing TreatmentsPancreatectomyPancreatic NeoplasmsAdultAgedFemaleFranceHumansMaleMiddle AgedPancreasPancreatic FistulaPostoperative ComplicationsRetrospective StudiesTreatment OutcomeAnatomical classificationEnucleationMini-invasive surgeryPancreatectomyParenchyma-sparing surgery

Identifiers

PMID39806174

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.