Comparative Outcomes of Parenchyma-Sparing Repeat Pancreatectomy versus Completion Pancreatectomy: Impact on Endocrine Function and Diabetes Management.

Abstract

Background: Although completion pancreatectomy (CP) is the standard approach for repeat pancreatectomy of secondary pancreatic tumors, the incidence of postoperative endocrine insufficiency is high. Parenchyma-sparing repeat pancreatectomy (PSRP) could preserve this function; however, its feasibility and long-term outcomes have not been evaluated. This study compared short-term outcomes and long-term endocrine pancreatic function between PSRP and CP.

Methods: Consecutive patients who underwent a second pancreatectomy between April 2005 and March 2024 at two high-volume centers were included. We compared the short- and long-term outcomes between the PSRP and CP groups. Serum HbA1c levels 6 months after surgery and the occurrence of hypoglycemic episodes were evaluated as indicators of endocrine function.

Results: Thirty patients (11 PSRP and 19 CP) were included. The two groups showed no significant differences in the preoperative or intraoperative findings. None of the patients in the PSRP group experienced major morbidity (Clavien-Dindo grade ≥ 3), while four patients (21%) in the CP group experienced major morbidity. HbA1c levels and the requirement for insulin therapy were significantly lower in the PSRP group (6.2% vs. 7.6%, p < 0.001 and 27% vs. 100%, p < 0.001). Hypoglycemic episodes were observed only in the CP group (4 patients).

Conclusion: PSRP might have favorable short-term outcomes and better long-term endocrine function than CP.