{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:06:53Z","timestamp":1790784413493,"version":"4.1.0"},"reference-count":59,"publisher":"American Medical Association (AMA)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"abstract":"\n Importance<\/jats:title>\n Pancreatic enucleation may offer a parenchyma-sparing alternative to pancreatoduodenectomy for benign and low-grade malignant pancreatic head tumors, but its perioperative risk-benefit profile relative to pancreatoduodenectomy remains incompletely defined.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare short-term outcomes and long-term quality of life after enucleation vs pancreatoduodenectomy for benign and low-grade malignant tumors of the pancreatic head and uncinate process.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multicenter, retrospective cohort study assessed patients undergoing enucleation or pancreatoduodenectomy for benign or low-grade pancreatic head or uncinate process tumors at 4 high-volume Chinese centers (January 1, 2015, to December 31, 2024; median follow-up, 36 months) with 1:1 propensity score matching. Data analysis was performed from March to May 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Pancreatic enucleation vs pancreatoduodenectomy.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary end point was clinically relevant postoperative pancreatic fistula (CR-POPF; International Study Group on Pancreatic Surgery grade B or C). Secondary end points included major complications (Clavien-Dindo grade III or higher), delayed gastric emptying, length of stay, long-term quality of life (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire and 26-item Quality of Life Pancreatic Cancer Questionnaire), and new-onset diabetes. Tumor-to-main pancreatic duct distance was evaluated through stratified and multivariable analyses.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 660 patients (297 undergoing enucleation and 363 undergoing pancreatoduodenectomy; 355 [53.8%] female; median [IQR] age, 55.0 [41.0-65.0] years), 217 matched pairs were formed. CR-POPF was higher after enucleation (72 [33.2%] vs 23 [10.6%]; adjusted odds ratio, 4.22; 95% CI, 2.47-7.21;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Major complications were lower (19 [8.8%] vs 37 [17.1%]; adjusted odds ratio, 0.37; 95% CI, 0.20-0.70;\n P<\/jats:italic>\n \u2009=\u2009.002) as was delayed gastric emptying (10 [4.6%] vs 55 [25.3%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Median (IQR) stay was 9 (6-14) vs 15 (11-22) days (\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). A total of 551 patients (83.5%) completed quality-of-life assessment; enucleation was associated with higher global health status (mean [SD] scores, 77.4 [13.7] vs 62.1 [18.0];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), lower new-onset diabetes (7.8% [20 of 257] vs 33.3% [98 of 294];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and higher return to work (92.7% [191 of 206] vs 72.0% [121 of 168];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Enucleation\u2019s complication advantage was greatest for tumors 2.5 cm or smaller (5.8% [6 of 104 patients] vs 26.2% [17 of 65 patients];\n P<\/jats:italic>\n \u2009for interaction =\u2009.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this multicenter cohort study, enucleation for benign and low-grade pancreatic head tumors was associated with higher CR-POPF than pancreatoduodenectomy but fewer major complications, less delayed gastric emptying, shorter hospitalization, and superior long-term quality of life. These findings support enucleation as a viable option when technically feasible, particularly for tumors 2.5 cm or smaller; residual tumor size imbalance after matching warrants prospective confirmation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2026.4498","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T15:31:49Z","timestamp":1790782309000},"source":"Crossref","is-referenced-by-count":0,"title":["Enucleation vs Pancreatoduodenectomy for Benign and Low-Grade Pancreatic Head Tumors"],"prefix":"10.1001","author":[{"given":"Zhengze","family":"Yao","sequence":"first","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanxing","family":"Gao","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weili","family":"Jia","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaohui","family":"Xiao","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjie","family":"Yin","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qu","family":"Liu","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Liu","sequence":"additional","affiliation":[{"name":"Faculty of Hepatopancreatobiliary Surgery, First Medical Center of Chinese People\u2019s Liberation Army (PLA) General Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"10","key":"soi260067r1","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.1001\/jamaoncol.2017.0589","article-title":"Trends in the incidence, prevalence, and survival outcomes in patients with neuroendocrine tumors in the United 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