Pancreas-sparing tumor enucleation for pancreatic mucinous cystic neoplasms: experience with two patients

Background. Because mucinous cystic neoplasms (MCNs) occur in the body and tail of the pancreas, distal pancreatectomy has been conventionally performed. However, enucleation can be adopted in selected patients, preserving the pancreatic parenchyma. Methods. We experienced two patients with MCN who underwent pancreatic tumor enucleation. Case 1 involved a very large MCN, 23cm across. Connective tissues between the tumor and the pancreatic parenchyma were not dense, so it was relatively easy to perform pancreatic cyst resection. Case 2 involved a MCN, 5cm across, located next to the body of the pancreas. Fibrotic changes were so dense that it was difficult to separate the tumor from the pancreatic parenchyma. Careful and gentle dissection enabled pancreas-sparing enucleation without injury to the cyst wall. Results. Enucleation of MCNs were performed successfully, preserving the pancreatic parenchyma. No complications were observed in either case. Conclusions. It is important to adopt the appropriate surgical procedure for MCN, considering the balance between radical resection and preservation of pancreatic function. Although careful attention should be paid to the assessment of malignant potential in each case of MCN, pancreas-sparing tumor enucleation can be considered as one of the treatment options in selected patients.