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Background: The most common management of small pancreatic cysts and neuroendocrine tumors is an extensive parenchymal resection. Standard resections for benign and borderline neoplasms of the pancreas, however, are associated with a significant risk of early morbidity and long-term functional impairment. In comparison,enucleation is a low-risk procedure that preserves healthy parenchyma and pancreatic function. The aim of this study was to evaluate the outcomes of pancreatic enucleations at a national level.Methods: The American College of Surgeons-National Quality Improvement Program (ACS-NSQIP) Participant Use File was queried for all patients undergoing a pancreatic enucleation (CPT code 48120) from 2005-2009. Patient demographics, preoperative variables, and post-operative morbidity and mortality were evaluated. Observed (O) and expected (E) morbidity and mortality as well as indices (O/E) were evaluated. An O/E ratio of less than 1.0 suggests that outcomes were better than expected.Results: Over the five year period, 347 patients had a pancreatic enucleation, which represents 3.1% of 11,026 pancreatic operations in the database. Fifty-seven percent of patients were female. The mean age and median BMI were 54.8 years and 27.9 kg/m2. Eighty-one percent of the enucleations were done for benign pancreatic diagnoses. After excision of a pancreatic lesion, 9.5% of patients had sepsis, and 8.9% developed organ space infection. Less than 3% of patients had any pulmonary complications and less than 2% had renal failure. No patients had any postoperative cardiac problems. The mean length of stay was 8 days. Only two patients died postoperatively. Overall morbidity and 30-day mortality were 19.8% and 0.58%, respectively. Morbidity and mortality indices were 1.21 and 0.58, respectively.Conclusion: Pancreatic enucleation is an uncommon but very safe procedure that preserves pancreatic function. For benign and premalignant pancreatic lesions, enucleation may be underutilized.