Pancreatic Enucleation: An Insight

Introduction:

Pancreatic enucleation is the surgical removal of a few types of low-grade or benign pancreatic tumors. Pancreatic tumors are removed with the involvement of minimum margins of the healthy pancreatic tissue. Therefore, it helps preserve healthy tissue so it can function normally.

What Is Enucleation?

Enucleation is the surgical procedure by which the cells of a tumor are removed from the body, leaving the healthy tissue intact. It can be done either by an open procedure or through laparoscopic means. By laparoscopic procedure, there is a quick recovery, and it is a minimally invasive procedure. There are various complications in which enucleation is preferred, like insulinoma (it is benign in maximum cases) and non-functioning tumors (with a size less tha two to three centimeters). The location of the tumor is one of the primary technical factors.

What Is Pancreatic Enucleation?

Pancreatic enucleation removes a few types of low-grade or benign pancreatic tumors by sparing the parenchyma. It can protect the normal parenchyma and reduce surgical trauma. With the help of pancreatic enucleation, both endocrine and exocrine functions of the pancreas can be saved by ensuring radicality. This procedure is opted best in case of benign and borderline cystic tumors of the pancreas. An open procedure, laparoscopic means, or robot-assisted method can do pancreatic enucleation. The outcomes of pancreatic enucleation were excellent in the long term.

What Are Pancreatic Tumors?

The pancreas is a gland in the abdomen that is responsible for helping in the process of digestion. It secretes digestive juices and enzymes, which help in digestion. A tumor is an abnormal growth of cells. When tumors form in this pancreatic gland, it is known as a pancreatic tumor. Pancreatic tumors prevent the pancreas functioning of the pancreas effectively. Depending on the cells which are involved, the tumor can affect its digestive or endocrine function, resulting in loss of appetite, sudden weight loss, abdominal pain, jaundice, changes in bowel movements, indigestion, gastroesophageal reflux (stomach contents flow back into the esophagus), diabetes, etc. Pancreatic tumors can turn dangerous if they spread to other parts of the body. Therefore, diagnosing them early and providing timely treatment is essential to prevent further complications.

What Are the Causes of Pancreatic Tumors?

The causes ofpancreatic tumors can be multiple. Some of them are described as:

• Chronic Pancreatitis: It results from excessive alcohol consumption and is also associated with a higher incidence and an earlier age of onset of pancreatic carcinoma.

• Smoking: Smoking cigarettes, cigars, and other forms of tobacco can result in causing pancreatic tumors.

• Obesity: It can cause pancreatic tumors, particularly if extra weight is present around the waist.

• Diabetes: Particularly Type 2 diabetes. Sudden-onset diabetes can be a sign of pancreatic cancer.

• Exposure to Certain Chemicals: These include pesticides and petrochemicals.

• Hereditary Chronic Pancreatitis: This occursdue to gene changes (mutations) passed from biological parent to child.

• Hereditary Syndromes With Changes (Mutations) in Genes: Like BRCA1 or BRCA2 genes, are passed from biological parent to child.

How Are Pancreatic Tumours Treated?

Multiple methods can treat pancreatic tumors, such as chemotherapy, hormone therapy, surgery, targeted therapy, and chemoembolization. Surgery involves the removal of the tumor along with a margin of healthy tissue. Sometimes, nearby organs such as the spleen, gallbladder, and parts of the stomach and small intestine may also be removed when the cancer spreads beyond the pancreas. This affects the normal functioning of the pancreas and other organs.

What Are the Indications for Enucleation of Pancreatic Tumours?

The enucleation procedure is advised for the removal of small tumors with a maximum diameter of 2 cm under the following conditions:

• Intraductal Papillary Mucinous Neoplasms (IPMNs): These are the tumors of the pancreatic duct.

• Benign endocrine tumors: these are the tumors originating from the hormone-producing pancreatic cells.

• Cystic lesions of the pancreas.

How Is the Preparation for Enucleation of Pancreatic Tumours Done?

Diagnosis is made per the medical history, physical examination, and the outcomes of the blood tests and tumor marker test. Magnetic Resonance Imaging (MRI), abdominal ultrasound, endoscopy, laparoscopy, or biopsy might be done for confirmation. Once pancreatic tumors are confirmed, the area to be operated on will be marked. The person might have to lie on their side or on the back, depending on the position of the tumor. They will be given a general anesthetic.

What Is the Procedure for Enucleation of Pancreatic Tumours?

Enucleation of pancreatic tumors can be done by following the following steps:

• A small cut is made, and the underlying tissues are separated. The surgeon might place non-resorbable sutures on the abdomen, which helps prevent bleeding and leakage of tumor cells into nearby healthy tissues.

• The tumor is removed by the use of specialized surgical tools, along with a very thin margin lying between the tumor and healthy pancreatic tissue.

• A tumor sample is withdrawn, frozen, and analyzed microscopically to confirm that it is benign and has not spread to other body parts.

• The incision is closed with resorbable sutures and a sealant.

What Are the Advantages of Enucleation of Pancreatic Tumours?

The advantages of enucleation of pancreatic tumors include:

• Preserves most of the pancreatic tissue and its functioning.

• Less blood loss.

• Shorter operation time.

• Shorter hospital stay.

• Quick recovery.

• There is less need for revision surgeries.

What Are the Risks and Complications of Enucleation of Pancreatic Tumours?

The risks and complications associated with the enucleation of pancreatic tumors might be:

• Pancreatic fistula caused by damage to pancreatic ducts, causing leakage of pancreatic secretions.

• Bleeding after surgery.

• Infections.

• Damage might be caused to the adjacent nerves or tissues.

Conclusion:

Pancreatic enucleation removes a few types of low-grade or benign pancreatic tumors by sparing the parenchyma. It can preserve normal parenchyma and reduce surgical trauma. Pancreatic enucleation can be recommended for benign endocrine tumors, cystic lesions of the pancreas, etc. Enucleation can be done by open method, laparoscopic way, or through robot-assisted surgery. This procedure has many benefits as it ensures the preservation of the functional structure, has a quick recovery, and time for surgery is needed less and less blood loss.