Incidence of Endocrine and Exocrine Pancreatic Insufficiency after Minimally Invasive Parenchyma-Sparing Pancreatectomy

Abstract

Background: Minimally invasive parenchyma-sparing pancreatectomy (MI-PSP) is being increasingly adopted for benign and low-grade pancreatic tumors. We sought to evaluate whether this approach is associated with reduced incidence of postoperative diabetes mellitus (DM) and pancreatic exocrine insufficiency (PEI).

Study design: We conducted a retrospective single-institution analysis of patients undergoing minimally invasive pancreatectomy between 2006 and 2024 for benign and low-grade pancreatic tumors, defined as localized neoplasms with a low risk of metastases. Propensity score matching (1:1) was performed to compare MI-PSP and minimally invasive standard pancreatectomy (MI-P) based on age, sex, BMI, preoperative non-insulin-dependent DM, and tumor size. The risk of developing postoperative new-onset or worsening DM and PEI was assessed using a multivariable regression model.

Results: A total of 184 patients were included. No significant difference emerged between the 2 groups regarding postoperative complications (Clavien-Dindo grade 3 or higher) within 90 days (p = 0.7). Among patients undergoing MI-P, 21 (23%) developed new-onset or worsening diabetes, with 11 (12%) requiring insulin. In contrast, among patients undergoing MI-PSP, only 9 (9.8%) developed new-onset or worsening diabetes, with 3 (3.3%) needing insulin treatment. The 5-year cumulative incidence risk of developing new-onset or worsening diabetes was 38.9% (95% CI 20.7 to 52.9) in the MI-P group and 26.7% (95% CI 7.5 to 42) in the MI-PSP group (p = 0.008). Similarly, PEI developed in 22% of MI-P vs 5.4% of MI-PSP patients (p = 0.001). In the multivariable analysis, patients undergoing MI-P exhibited a significantly higher risk of developing new-onset or worsening diabetes (hazard ratio 3.06, p = 0.006) and PEI (odds ratio 3.18, p = 0.037) compared with those receiving MI-PSP.

Conclusions: MI-PSP was associated with a lower incidence of postoperative metabolic complications in the management of benign and low-grade pancreatic tumors.