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Middle Pancreatectomy for Low-Grade Malignancies: Superior Long-Term Glucose Tolerance Preservation Over Distal
Atsuro Fujinaga1, Minoru Esaki1, Kei Kitamura1
1Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan.
Background:
This study compared outcomes of middle pancreatectomy (MP) and distal pancreatectomy (DP), focusing on long-term glucose tolerance.
Methods:
We retrospectively reviewed 282 patients who underwent MP (n = 69) or DP (n = 213) for low-grade malignant tumors from 2000 to 2020. Surgical outcomes, HbA1c levels, prevalence of diabetes mellitus (DM), and escalation of antidiabetic medication were analyzed.
Results:
MP was associated with longer operation time (312 vs. 245 min, p < 0.001) and higher pancreatic fistula rate (64% vs. 47%, p = 0.018). Among 248 patients with 3-year follow-up, MP showed lower HbA1c levels (5.9% vs. 6.3%, p < 0.001), lower incidence of new-onset DM (3% vs. 30%, p < 0.001), and fewer cases of increased antidiabetic medication use (8% vs. 24%, p = 0.005). Insulin therapy was newly required in 1 MP case versus 18 DP cases.
Conclusion:
Despite higher morbidity, MP demonstrated superior preservation of long-term glucose tolerance compared with DP. These findings suggest that MP is a valuable parenchyma-preserving option for patients with low-grade malignant pancreatic tumors, particularly those at increased risk of postoperative DM, although careful consideration of surgical risks is required.
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