Pancreatic enucleation, despite higher rates of clinically relevant postoperative pancreatic fistula (CR-POPF), shows significant benefits over pancreatoduodenectomy for benign or low-grade tumors in terms of major complications, hospitalization duration, and long-term quality of life.

• CR-POPF occurred in 33.2% of enucleation patients compared to 10.6% after pancreatoduodenectomy, but enucleation had 50% fewer major complications (8.8% vs 17.1%).
• Enucleation resulted in shorter hospital stays (9 vs 15 days) and was linked to better quality of life scores (77.4 vs 62.1).
• If considering enucleation, it may be particularly advantageous for tumors 2.5 cm or smaller, where the complication rates differed significantly.

Surgeons should weigh the risks and benefits carefully, especially for smaller tumors.