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BACKGROUND: Pancreatic enucleation is associated with a lower postoperative mortality than pancreatic resection. Enucleation also has the potential advantages of reduced morbidity and preservation of pancreatic parenchyma. However, enucleation is an uncommon operation, and good comparative data with resection are lacking. Therefore, the aim of this analysis was to compare the outcomes of pancreatic enucleation and resection.METHODS: From 1998 through 2010, 45 patients with small (mean 2.3 cm, range 0.5-5.5 cm) neuroendocrine tumors (49%), mucinous cystic tumors (22%), serous/simple cysts (20%) and other benign lesions (9%) underwent pancreatic enucleation. Since 2005, 16 of 31 enucleations (52%) were performed laparoscopically or robotically. These 45 patients were matched by age, gender, pathology, lesion size and location as well as by year of surgery and approach (open vs. laparoscopic or robotic) with 45 patients undergoing pancreatoduodenectomy (n=19) or distal pancreatectomy (n=26). Serious morbidity included Grade B and C pancreatic fistuls and was otherwise defined in accordance with the American College of Surgeons- National Surgical Quality Improvement Program. Outcomes were compared with standard statistical analyses.RESULTS: Operative time was nearly two hours shorter for enucleation (183 vs 279 mins, p<0.05). Operative blood loss was significantly lower with enucleation (160 vs 788 ml, p<0.05). Fewer patients undergoing enucleation required monitoring in an Intensive Care Unit (18 vs 44%, p<0.05). Serious morbidity was significantly less among patients who underwent enucleation compared to those who had a resection (13 vs 36%, p<0.05). None of the 45 enucleation patients died within 30 days whereas one resection patient (2.2%) died postoperatively. Median postoperative length of stay was two days less for enucleation patients (6 vs 8 days). Only three enucleation patients (7%), all with insulinomas, developed new postoperative diabetes, and none had new exocrine insufficiency after surgery.CONCLUSION: Compared to resection, pancreatic enucleation is associated with improved operative and postoperative outcomes. For small benign and premalignant pancreatic lesions, enucleation should be considered the procedure of choice when technically appropriate.