Background: Laparoscopic surgery is being increasingly used for pancreatic neuroendocrine neoplasms (PanNENs). Although laparoscopic regular pancreatectomy (LRP) is frequently performed, laparoscopic enucleation (LE), a parenchyma-sparing technique, may be better in preserving pancreatic endocrine function. However, limited evidence is available regarding the long-term oncological and endocrine outcomes of these two laparoscopic methods. This study aimed to compare the surgical and prognostic outcomes and endocrine function preservation in patients undergoing LE and LRP for well-differentiated, non-invasive PanNEN. Methods: This retrospective cohort study included 67 consecutive patients who underwent laparoscopic surgery for small (< 2 cm) well-differentiated PanNEN at Tohoku University Hospital between January 2001 and December 2021. LE was performed for small tumors (< 2 cm) located away (> 3 mm) from the main pancreatic duct. Clinical characteristics, surgical details, tumor characteristics, postoperative complications, recurrence-free survival (RFS), overall survival (OS), and long-term endocrine function were retrospectively analyzed. Kaplan–Meier analysis, Cox regression, and the Mann–Whitney U test were used for statistical comparisons. Results: The median follow-up was 78.1 months for LRP and 135.4 months for LE. No significant differences were observed between the two groups in terms of the operative time, blood loss, or postoperative complications. Five-year RFS was excellent and comparable in both groups (LE, 100%, LRP 96.0%; P = 0.313). Notably, LE was associated with a significantly reduced incidence of postoperative new-onset diabetes mellitus (NODM) compared to LRP (5-year cumulative incidence: 9.1% vs. 43.2%; P = 0.0181). Multivariate analysis identified LRP (hazard ratio [HR] = 7.71, 95% confidence interval [CI]:1.03–57.8; P = 0.0469), older age (> 60 years) (HR = 4.49, 95% CI 1.62–12.4; P = 0.0039), and non-functional tumor (HR = 2.78, 95% CI 1.08–7.19; P = 0.0342) as independent predictors of NODM. Conclusion: Given appropriate patient selection, LE of small well-differentiated PanNENs provides comparable oncological outcomes, perioperative safety, and superior long-term endocrine function preservation compared to LRP.

Surgical resection is the only curative treatment for perihilar cholangiocarcinoma (pCCA); however, the majority of patients experience postoperative recur

INTRODUCTION: Although several studies have highlighted the importance of recognizing gastroduodenal artery (GDA) anomalies during pancreaticoduodenectomy, their relevance during distal pancreatectomy has not been explored. Herein, we describe the safe performance of laparoscopic distal pancreatectomy in a patient with a rare vascular anomaly, specifically a GDA originating from the superior mesenteric artery (SMA).CASE PRESENTATION: A 63-year-old woman presented with recurrent pancreatitis due to a cystic lesion in the pancreatic body. Imaging suggested a branch-duct intraductal papillary mucinous neoplasm with substantial ductal stenosis. Multidetector CT (MDCT) revealed a rare anatomical variant: the GDA, arising from the SMA and traversing along the inferior border of the pancreas. Laparoscopic distal pancreatectomy was performed after placing an endoscopic nasopancreatic drainage tube. The aberrant GDA was successfully preserved through careful dissection and vessel loop isolation. Pancreatic transection was completed without vascular injury. A postoperative pancreatic fistula developed and was conservatively managed. Histopathological examination confirmed that the lesion was an intraductal papillary mucinous carcinoma without any invasive features. Follow-up MDCT revealed sustained patency and perfusion of the preserved GDA, right gastroepiploic artery, and anterior superior pancreaticoduodenal artery.CONCLUSIONS: Laparoscopic pancreatectomy can be safely performed in patients with SMA-derived GDA anomalies, when supported by detailed preoperative imaging and precise intraoperative techniques. These findings highlight the necessity of routine preoperative vascular assessment in patients undergoing minimally invasive pancreatic surgery, reinforcing the broader applicability of these approaches for patients with complicated vascular anatomy.