Pancreatic exocrine insufficiency after distal pancreatectomy - an underestimated challenge

Background While endocrine insufficiency after distal pancreatectomy (DP) has been extensively studied, data on pancreatic exocrine insufficiency (PEI) following DP remain limited. This study aimed to evaluate the characteristics and clinical relevance of PEI after DP. Methods 184 patients who underwent DP between June 2013 and December 2022 were retrospectively analyzed. Demographics, perioperative parameters and postoperative outcomes were evaluated. Follow-up time was 24 months. Results Postoperative de-novo PEI occurred in 48.4% of patients. Patients who developed PEI had a lower BMI (24.2 vs. 26.1 kg/m², p = 0.016), more postoperative complications (48.4% vs. 66.3%, p = 0.02), a higher prevalence of malignant disease (69.7% vs. 55.8%, p = 0.07), particularly pancreatic ductal adenocarcinoma (48.3% vs. 29.5%, p = 0.02). Multivariate analysis identified a longer operative time (OR 1.407, 95% CI 1.096 –1.807, p = 0.007) and major complications (Clavien–Dindo > II; OR 3.153, 95% CI 1.569–6.337, p = 0.007) as independent predictors for the development of postoperative PEI. Lower preoperative BMI also showed an effect on new onset postoperative PEI (OR 0.887, 95% CI 0.814–0.966, p = 0.006). Conclusion PEI is frequent and its development is influenced by individual patient factors, the extent of resection, and the postoperative course. These findings underscore the importance of PEI as one key parameter in pancreatic surgery.