Abstract
<title>Abstract</title> <p>Background 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 the main pancreatic duct (MPD) remains limited. Methods 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. Results The mean patient age was 51.5 ± 14.2 years, with median tumor size 25.0 mm (IQR 15.0–36.0) and median distance to the MPD 1.7 mm (IQR 0.8–2.6); 31.3% of lesions abutted the MPD. All procedures were completed without mortality. Median operative time was 127.5 minutes (IQR 90.0-180.0) with median estimated blood loss of 20.0 mL (IQR 20.0–50.0). Clinically relevant postoperative pancreatic fistula (ISGPS Grade B/C) was reported in 56.3% of cases. No patients developed new-onset insulin-dependent diabetes or clinically significant exocrine insufficiency during 6-month follow-up. Conclusions LPEn is feasible for near-MPD lesions with zero mortality and preserved endocrine and exocrine function, when meticulous intraoperative ultrasound (IOUS) guidance and selective MPD stenting are employed, as demonstrated in this single-center series. These data support a selective expansion of LPEn indications, with careful patient selection balancing the inherently high fistula risk against the long-term benefits of pancreatic function preservation.</p>