Single-Stage Endoscopic Retrograde Cholangiopancreatography Combined with Laparoscopic Enucleation of Pancreatic Cystic Neoplasms

Pancreatic cystic neoplasms (PCNs) represent a heterogeneous group of lesions, with some specific subtypes harboring malignant potential or exhibiting low-grade malignancy. Surgical resection remains the primary treatment modality. Traditional pancreatoduodenectomy is associated with severe trauma and slow recovery, while minimally invasive methods like laparoscopic central pancreatectomy (LCP) mitigate these issues; Laparoscopic enucleation (LE), a common procedure in function-preserving surgery, carries a risk of postoperative pancreatic fistula (POPF) for PCNs adjacent to the main pancreatic duct (MPD). While laparoscopic enucleation paired with two-staged endoscopic retrograde cholangiopancreatography (ERCP-LE) can mitigate POPF, this approach increases the length of hospital stay (LOS). Thus, we applied single-stage ERCP-LE for the treatment of PCNs, fully leveraging the advantages of both techniques. This approach enables the simultaneous performance of ERCP-guided pancreatic duct mapping, transpapillary stent placement, and laparoscopic enucleation of the target lesion during a single operative session. The technique boasts prominent advantages and pioneering value: it completes multi-step procedures in one stage, avoiding interval pancreatitis associated with staged operations while shortening treatment duration, reducing the risks of repeated anesthesia, stent migration, and additional costs; ERCP-guided stent placement minimizes injury to the MPD, facilitates immediate repair if injury occurs, and diverts pancreatic juice to significantly lower the incidence of POPF and pancreatitis. As an innovative therapeutic approach for high-risk PCNs adjacent to the MPD, single-stage ERCP-LE overcomes the limitations of traditional surgery and two-staged ERCP-LE. It is therefore expected to become the standard treatment for PCNs adjacent to the MPD, enabling more precise minimally invasive therapy while significantly preserving pancreatic function.