Functional Advantage of Central Pancreatectomy Over Distal Pancreatectomy for Benign or Low-Grade Malignant Tumors: A...

Central pancreatectomy (CP) is a function-preserving procedure for benign or low-grade malignant lesions in the pancreatic neck or proximal body. However, endocrine function after CP has not been objectively evaluated.

We retrospectively analyzed 123 patients who underwent CP (n = 38) or distal pancreatectomy (DP; n = 85) for benign or low-grade malignant tumors. Short- and long-term outcomes were compared between groups. Among 37 patients (CP; n = 12, DP; n = 25) underwent a 75-g oral glucose tolerance test (OGTT) before and 1 month after surgery to evaluate endocrine function.

CP was associated with a higher incidence of postoperative pancreatic fistula than DP (40% vs. 8%; p < 0.001). All CP patients achieved R0 resection with no perioperative mortality or tumor recurrence. The incidence of new-onset diabetes mellitus was significantly lower after CP than after DP (14.8% vs. 50.9%, p = 0.002). In the DP group, the area under the curve (AUC) for blood glucose (BG) increased postoperatively (p < 0.001), whereas AUCs for immunoreactive insulin (IRI) and C-peptide immunoreactivity (CPR) decreased (p = 0.010 and p = 0.022, respectively). Conversely, the CP group showed preserved endocrine function, with no significant postoperative changes in AUCs for BG (p = 0.351), IRI (p = 0.723), or CPR (p = 0.900).

Compared with DP, which has acceptable short-term outcomes, CP preserves pancreatic endocrine function. In patients with benign or low-grade malignant pancreatic tumors with expected long-term survival, CP should be considered over DP to preserve function.