Surgery plays a key role in the treatment of pancreatic neuroendocrine tumors (PanNETs). Enucleation combines a radical resection with sparing of healthy pancreatic parenchyma.

To evaluate short- and long-term outcomes of open enucleation for PanNETs, clinical records of patients operated from 1979 to 2021 in our Pancreatic Surgical Unit were retrieved retrospectively. Follow-up closed in December 2022.

Out of 246 PanNET operated, 62 patients underwent enucleation: 39 women and 23 men, averaging 57 years. Pancreatic NETs were mostly insulinomas (64.5%), located in the head/uncinate process (61.3%), grade 1 (73.9%) with median size of 1.5 (range, 0.7-9.0) cm. Median operation time was 180 (range, 90-275) minutes, median intraoperative blood loss was 100 (range, 10-600) ml. Pancreatic fistula (all grade B) occurred in ten (16%) patients. One reoperation required for evisceration. Median hospital stay was ten (range, 5-49) days, postoperative mortality nihil. After a median follow-up of 158 (range, 12-479) months, seven new onset diabetes but no exocrine insufficiency occurred. Fourteen patients died of other causes after a median OS of 203 months.

Enucleation of PanNETs resulted in excellent long-term results, both for pancreatic function and oncological outcomes. In open surgery postoperative morbidity is not negligible, but it does not affect patients' prognosis.