{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T15:24:54Z","timestamp":1784733894656,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Parenchyma-sparing pancreatic surgery (PSPS) is a patient-centered alternative to traditional radical resections for benign and low-grade pancreatic lesions. Unlike pancreaticoduodenectomy and distal pancreatectomy, which tend to cause long-term exocrine and endocrine deficiency, PSPS aims to preserve functional tissue with a guarantee of oncologic safety. Techniques such as enucleation, central pancreatectomy, duodenum-preserving head resection, and uncinectomy are illustrative of this equipoise, with less risk of new-onset diabetes and malabsorption but more short-term morbidity in the form of postoperative pancreatic fistula. Advances in imaging technology, minimally invasive procedures, and robotics technology have extended PSPS indications beyond conventional candidates to thoughtfully selected neuroendocrine tumors, cystic neoplasms, and solid pseudopapillary neoplasms. Results are strongly dependent on patient selection, surgeon experience, and institutional volume, highlighting the importance of centralization and subspecialist training. While oncologic proficiency remains essential in aggressive tumors, evidence is in favor of PSPS being a curative and function-preserving option for properly screened patients with low-grade or benign conditions. Priorities for the future include multicenter prospective trials, optimization of perioperative techniques, and inclusion of patient-reported outcomes. PSPS represents a paradigm shift in pancreatic surgery, where technical innovation is balanced with quality of life in the long term and evolving principles of modern, individualized surgical practice.<\/jats:p>","DOI":"10.3390\/cancers18101550","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:05:22Z","timestamp":1778501122000},"page":"1550","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Parenchyma-Sparing Pancreatic Surgery: Current Indications, Results, and Future Prospects"],"prefix":"10.3390","volume":"18","author":[{"given":"Silvio","family":"Caringi","sequence":"first","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7759-4340","authenticated-orcid":false,"given":"Antonella","family":"Delvecchio","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"},{"name":"Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annachiara","family":"Casella","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Ferraro","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Stasi","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nunzio","family":"Tralli","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4636-3478","authenticated-orcid":false,"given":"Tommaso Maria","family":"Manzia","sequence":"additional","affiliation":[{"name":"Transplant and HPB Unit, Department of Surgery Sciences, University of Rome Tor Vergata, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2101-5418","authenticated-orcid":false,"given":"Michele","family":"Tedeschi","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"},{"name":"Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1668-932X","authenticated-orcid":false,"given":"Riccardo","family":"Memeo","sequence":"additional","affiliation":[{"name":"Unit of Hepato-Biliary and Pancreatic Surgery, \u201cF. Miulli\u201d General Hospital, 70021 Acquaviva delle Fonti, Italy"},{"name":"Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e20","DOI":"10.1055\/s-0044-1782655","article-title":"Central Pancreatectomy: Balancing between the Favorable Functional Results and the Increased Associated Morbidity","volume":"10","author":"Symeonidis","year":"2024","journal-title":"Surg. J."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Marchese, U., Tzedakis, S., Abou Ali, E., Turrini, O., Delpero, J.-R., Coriat, R., and Fuks, D. (2021). Parenchymal Sparing Resection: Options in Duodenal and Pancreatic Surgery. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071479"},{"key":"ref_3","first-page":"2025","article-title":"Effectiveness and safety of central pancreatectomy in benign or low-grade malignant pancreatic body lesions: A systematic review and meta-analysis","volume":"109","author":"Bi","year":"2023","journal-title":"Int. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1097\/SLA.0000000000006157","article-title":"Tailoring the Use of Central Pancreatectomy Through Prediction Models for Major Morbidity and Postoperative Diabetes: International Retrospective Multicenter Study","volume":"280","author":"Lof","year":"2024","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1002\/jhbp.1296","article-title":"Central pancreatectomy prevents postoperative diabetes","volume":"30","author":"Klotz","year":"2023","journal-title":"J. Hepatobil. Pancreat. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Cao, Y., Zhao, R., Guo, K., Ren, S., Zhang, Y., Lu, Z., Tian, L., Li, T., Chen, X., and Wang, Z. (2022). Potential Metabolite Biomarkers for Early Detection of Stage-I Pancreatic Ductal Adenocarcinoma. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.744667"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1007\/s00423-011-0801-z","article-title":"Enucleation in pancreatic surgery: Indications, technique, and outcome compared to standard pancreatic resections","volume":"396","author":"Hackert","year":"2011","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1007\/s11605-013-2355-6","article-title":"Enucleation of pancreatic lesions: Indications, outcomes, and risk factors for clinical pancreatic fistula","volume":"17","author":"Zhang","year":"2013","journal-title":"J. Gastrointest. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1245\/s10434-010-0949-8","article-title":"Parenchyma-preserving resections for small nonfunctioning pancreatic endocrine tumors","volume":"17","author":"Falconi","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3722","DOI":"10.3748\/wjg.v25.i28.3722","article-title":"Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery","volume":"25","author":"Kawaida","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1007\/s00464-010-1223-7","article-title":"Laparoscopic enucleation of pancreatic neoplasm","volume":"25","author":"Dedieu","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1254","DOI":"10.1002\/bjs.5833","article-title":"Enucleation of pancreatic neoplasms","volume":"94","author":"Crippa","year":"2007","journal-title":"Br. J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1002\/ags3.12446","article-title":"The current status and future directions of robotic pancreatectomy","volume":"5","author":"Nakata","year":"2021","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.hpb.2018.04.003","article-title":"Systematic review and meta-analysis of postoperative pancreatic fistula rates using the updated 2016 International Study Group Pancreatic Fistula definition in patients undergoing pancreatic resection with soft and hard pancreatic texture","volume":"20","author":"Eshmuminov","year":"2018","journal-title":"HPB"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1001\/archsurg.133.3.327","article-title":"Middle segment pancreatectomy: A novel technique for conserving pancreatic tissue","volume":"133","author":"Warshaw","year":"1998","journal-title":"Arch. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/j.ejso.2018.11.021","article-title":"Central pancreatectomy for benign or low-grade malignant pancreatic lesions\u2014A single-center retrospective analysis of 116 cases","volume":"45","author":"Paiella","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15674","DOI":"10.3748\/wjg.v20.i42.15674","article-title":"Central pancreatectomy: The Dagradi Serio Iacono operation. Evolution of a surgical technique from the pioneers to the robotic approach","volume":"20","author":"Iacono","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1097\/01.sla.0000189124.47589.6d","article-title":"Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: Results of a comparative study","volume":"242","author":"Bassi","year":"2005","journal-title":"Ann. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8","DOI":"10.21037\/apc-21-7","article-title":"The robotic central pancreatectomy: Surgical technique, and literature review","volume":"4","author":"Kotecha","year":"2021","journal-title":"Ann. Pancreat. Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1001\/jamasurg.2013.4146","article-title":"Reappraisal of central pancreatectomy a 12-year single-center experience","volume":"149","author":"Goudard","year":"2014","journal-title":"JAMA Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1007\/s00464-009-0825-4","article-title":"Robot-assisted laparoscopic pancreatic surgery: Single-surgeon experience","volume":"24","author":"Giulianotti","year":"2010","journal-title":"Surg. Endosc."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1097\/00000658-198903000-00004","article-title":"Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results","volume":"209","author":"Beger","year":"1989","journal-title":"Ann. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3859","DOI":"10.1007\/s00423-022-02512-w","article-title":"Laparoscopic duodenum-preserving total pancreatic head resection for pancreatic tumors: The difficult balance among overtreatment, ideal treatment, and undertreatment","volume":"407","author":"Boggi","year":"2022","journal-title":"Langenbeck\u2019s Arch. Surg."},{"key":"ref_24","first-page":"602478","article-title":"Pancreatic fistula after pancreatectomy: Definitions, risk factors, preventive measures, and management-review","volume":"2012","author":"Machado","year":"2012","journal-title":"Int. J. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1007\/s00117-008-1669-y","article-title":"Indikationen zur chirurgischen Therapie benigner Pankreastumoren [Indications for surgical resection of benign pancreatic tumors]","volume":"48","author":"Isenmann","year":"2008","journal-title":"Radiologe"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/bjs.5982","article-title":"Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy","volume":"95","author":"Balzano","year":"2008","journal-title":"Br. J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1001\/archsurg.138.12.1310","article-title":"Changes in morbidity after pancreatic resection: Toward the end of completion pancreatectomy","volume":"138","author":"Wagner","year":"2003","journal-title":"Arch. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.gassur.2006.08.018","article-title":"1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience","volume":"10","author":"Winter","year":"2006","journal-title":"J. Gastrointest. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000335587","article-title":"ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: Well-differentiated pancreatic non-functioning tumors","volume":"95","author":"Falconi","year":"2012","journal-title":"Neuroendocrinology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1136\/gutjnl-2015-309638","article-title":"Serous cystic neoplasm of the pancreas: A multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas)","volume":"65","author":"Jais","year":"2016","journal-title":"Gut"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.jamcollsurg.2005.02.011","article-title":"Solid pseudopapillary tumors of the pancreas: Review of 718 patients reported in English literature","volume":"200","author":"Papavramidis","year":"2005","journal-title":"J. Am. Coll. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Paik, W.H., and Lee, K.J. (2022). Management of Small Nonfunctioning Pancreatic Neuroendocrine Neoplasms: Current Opinion and Controversies. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010251"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s00268-009-0290-1","article-title":"Risk factors and causes of death in MEN1 disease. A GTE (Groupe d\u2019Etude des Tumeurs Endocrines) cohort study among 758 patients","volume":"34","author":"Goudet","year":"2010","journal-title":"World J. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.pan.2017.07.007","article-title":"Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas","volume":"17","author":"Tanaka","year":"2017","journal-title":"Pancreatology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/MPA.0000000000000061","article-title":"A systematic review of solid-pseudopapillary neoplasms: Are these rare lesions?","volume":"43","author":"Law","year":"2014","journal-title":"Pancreas"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/01.sla.0000251438.43135.fb","article-title":"Distal pancreatectomy: Risk factors for surgical failure in 302 consecutive cases","volume":"245","author":"Kleeff","year":"2007","journal-title":"Ann. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"E2387","DOI":"10.1210\/jc.2013-4432","article-title":"Higher risk of aggressive pancreatic neuroendocrine tumors in MEN1 patients with MEN1 mutations affecting the CHES1 interacting MENIN domain","volume":"99","author":"Bartsch","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1887","DOI":"10.1245\/s10434-024-16702-x","article-title":"Mitigating Postoperative Fistula Risks in Laparoscopic Pancreatic Enucleation: A Retrospective Study","volume":"32","author":"Li","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"4637","DOI":"10.1245\/s10434-024-15222-y","article-title":"Long-Term Oncologic Outcome following Duodenum-Preserving Pancreatic Head Resection for Benign Tumors, Cystic Neoplasms, and Neuroendocrine Tumors: Systematic Review and Meta-analysis","volume":"31","author":"Beger","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MPA.0000000000001454","article-title":"The North American Neuroendocrine Tumor Society Consensus Paper on the Surgical Management of Pancreatic Neuroendocrine Tumors","volume":"49","author":"Howe","year":"2020","journal-title":"Pancreas"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Zheng, R., Ghabi, E., and He, J. (2023). Robotic Parenchymal-Sparing Pancreatectomy: A Systematic Review. Cancers, 15.","DOI":"10.3390\/cancers15174369"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"89","DOI":"10.21037\/hbsn-23-132","article-title":"International consensus guidelines on robotic pancreatic surgery in 2023","volume":"13","author":"Liu","year":"2024","journal-title":"Hepatobil. Surg. Nutr."},{"key":"ref_43","first-page":"518","article-title":"Neuroendocrine tumors\u2019 patients treated with somatostatin analogue could complicate with emergency cholecystectomy","volume":"94","author":"Calomino","year":"2023","journal-title":"Ann. Ital. Chir."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1550\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T12:24:55Z","timestamp":1778502295000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/10\/1550"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,11]]},"references-count":43,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["cancers18101550"],"URL":"https:\/\/doi.org\/10.3390\/cancers18101550","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,11]]}}}