Despite a decline in the overall indications for total pancreatectomy (TP), there remains a subset of patients who require removal of the entire pancreas. However, comparative data between organ-preserving modified TP and the classic approach are scarce, and the post-TP diabetes mellitus has unique characteristics. We conducted an ambispective comparative cohort study of 62 patients divided into two groups: Group 1 (n = 30) underwent an organ-preserving TP with preservation of the stomach and spleen, and Group 2 (n = 32) underwent classic TP including distal gastrectomy and splenectomy. We analyzed perioperative outcomes as well as postoperative glucose metabolism. We assessed daily insulin requirements, glycated hemoglobin (HbA1c), body mass index (BMI), and need for enzyme replacement therapy and nutritional support. No postoperative deaths occurred in Group 1, whereas Group 2 had a 15.6% mortality rate. Group 1 had significantly fewer severe complications (Clavien–Dindo grade ≥ IV: 6.7% vs 31.3%) and no hemorrhagic complications (0% vs 25%, p = 0.005). Severe hypoglycemic episodes were significantly reduced in Group 1 (23.3% vs 64.5%, p = 0.433). Although Group 1 required higher daily insulin doses (31.2 vs 22.8 IU, p = 0.035), this reflected improved nutritional intake and absorption. Organ-preserving TP improves short-term safety and facilitates diabetes management compared to classic TP. Preservation of the gastro-splenic venous axis significantly reduces hemorrhagic risks, while pyloric preservation stabilizes glycemic control.
Shabunin et al. (Wed,) studied this question.