Enucleation trades more fistula for fewer major complications in low-grade head tumours

Design

Multicentre retrospective cohort, 1:1 propensity-score matched; median follow-up 36 months

Population

660 patients (217 matched pairs) with benign or low-grade pancreatic head or uncinate tumours

Primary outcome

Clinically relevant postoperative pancreatic fistula (grade B or C)

Effect

Fistula 33.2% vs 10.6% (aOR 4.22, 2.47 to 7.21); major complications 8.8% vs 17.1% (aOR 0.37, 0.20 to 0.70)

A multicentre retrospective cohort from four high-volume Chinese centres compared pancreatic enucleation with pancreatoduodenectomy for benign and low-grade malignant tumours of the pancreatic head and uncinate process, using 1:1 propensity matching to form 217 matched pairs from 660 patients.

The trade-off was clear. Enucleation produced more clinically relevant postoperative pancreatic fistula (33.2% vs 10.6%; adjusted odds ratio 4.22, 95% CI 2.47 to 7.21) but fewer major complications (8.8% vs 17.1%; adjusted odds ratio 0.37, 0.20 to 0.70), far less delayed gastric emptying (4.6% vs 25.3%), and a shorter stay (median 9 vs 15 days). Long-term it was associated with less new-onset diabetes (7.8% vs 33.3%) and better quality of life. The complication advantage was greatest for tumours of 2.5 cm or smaller.

Where a head tumour is benign or low-grade and the lesion sits far enough from the main duct, enucleation is worth weighing as a parenchyma-sparing option — accepting a higher fistula rate in exchange for lower major morbidity and better long-term function.

• Multicentre cohort, 660 patients, 217 propensity-matched pairs; benign or low-grade pancreatic head tumours.
• Clinically relevant pancreatic fistula was higher after enucleation: 33.2% vs 10.6% (adjusted odds ratio 4.22, 95% CI 2.47 to 7.21).
• Major complications were lower (8.8% vs 17.1%) and delayed gastric emptying far less common (4.6% vs 25.3%).
• New-onset diabetes was lower after enucleation (7.8% vs 33.3%) with better reported quality of life.
• The advantage was largest for tumours 2.5 cm or smaller; consider duct distance when selecting the approach.

Why it matters

It reframes the choice as a managed trade-off — more fistula against less major morbidity and better long-term function — rather than defaulting to the larger resection.

Don't overread it

This was a retrospective, propensity-matched cohort with residual tumour-size imbalance; it supports enucleation as an option, it does not prove superiority.

The statistics, in plain English

The fistula odds ratio of 4.22 with an interval well above 1.0 is a real and large increase; the complication odds ratio of 0.37 with an interval below 1.0 is a real reduction. Because this is retrospective and matched, residual differences between groups may still inflate the apparent advantage.

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