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Assessment of long-term endocrine sequelae of completion (2-stage) versus total (single-stage) pancreatectomy: A
Michael L Chang1, Matthew Kraft1, Zachary Kaplan1
1Jefferson Pancreas, Biliary and Related Cancer Center, Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Background:
Total pancreatectomy can be associated with severe endocrine complications. This study compares endocrine outcomes of patients who underwent a single-stage total pancreatectomy versus a 2-stage completion pancreatectomy.
Methods:
We used data from a multi-institutional research network (TriNetX), which identified 1,079 propensity score-matched total pancreatectomy and completion pancreatectomy patient pairs for age, gender, and race. These data were validated by a single-center review of a prospectively maintained database of 1,600 pancreatectomies, from which 88 completion and total pancreatectomy patients treated between 2013 and 2023 were identified. The primary endpoints were postoperative rates of hypoglycemia and diabetic ketoacidosis during the first year following surgery.
Results:
The network analysis identified 1,079 propensity score-matched total pancreatectomy and completion pancreatectomy pairs with similar demographics. During the first year following the surgery, patients in the total pancreatectomy cohort had a 2.9-fold increased risk of endocrine complications compared with the completion pancreatectomy cohort (hazard ratio 2.9, 95% confidence interval 2.2-3.7, P < .00001). Total pancreatectomy patients had an increased risk of hypoglycemia (hazard ratio 3.0, 95% confidence interval 2.2-4.0, P < .00001) and an increased risk of diabetic ketoacidosis (hazard ratio 9.3, 95% confidence interval 4.0-21.7, P < .0001). In the single-center analysis, total pancreatectomy patients showed a 3.9-fold (hazard ratio 3.9, 95% confidence interval 1.2-13.0, P = .025) higher hypoglycemia rate than completion pancreatectomy patients. Kaplan-Meier analyses demonstrated that total pancreatectomy patients experienced earlier and more frequent hypoglycemic events compared with completion pancreatectomy patients both in the multi-institutional cohort (P < .00001) and in the single-center validation cohort (P < .01).
Conclusions:
Our findings indicate that 2-stage completion pancreatectomy patients experience fewer endocrine complications than total pancreatectomy patients. The higher early postoperative endocrine complication rates in total pancreatectomy patients underscore the need for vigilant monitoring and improved patient education in this patient cohort.
