Main pancreatic duct exposure, repair or reconstruction During minimally invasive pancreatic enucleation long-term metabolic outcome From a prospective cohort study (CSPAC-MIEN-1).

Background: While minimally invasive enucleation (MIEN) is known for its excellent long-term metabolic outcomes and comparable quality of life (QoL) to that of the general population, previous reports have rarely included exposure, repair, or reconstruction (ERR) of the main pancreatic duct (MPD). This study aims to assess the long-term pancreatic metabolic outcomes and QoL in patients following MIEN involving MPD ERR.

Method: From July 2019 to April 2024, 230 patients were prospectively enrolled. Among them, 93 patients underwent MPD ERR (exposure = 30, suture repair = 17, reconstruction with stenting = 46), while the remaining 137 patients did not have MPD exposure. A textbook outcome specific to MIEN was defined. Metabolic outcomes were assessed, with QoL assessed at the 1-year postoperative mark.

Results: MPD ERR significantly increased perioperative complication rates compared to the non-exposed group, including higher occurrences of clinically relevant postoperative pancreatic fistula (79.6% vs. 41.6%, P<0.001), hemorrhage (16.1% vs. 2.2%, P<0.001), delayed gastric emptying (10.8% vs. 1.5%, P = 0.002), abdominal infection (51.6% vs. 20.4%, P<0.001), and readmission (26.9% vs. 11.7%, P = 0.003). It also impeded the achievement of textbook outcomes (11.8% vs. 51.1%, P<0.001). The MPD ERR group experienced 9 cases of pancreatitis, 14 instances of MPD dilatation, 1 occurrence of stone formation, and 4 cases of pancreatic atrophy, predominantly in the reconstruction with stenting subgroup. However, long-term pancreatic endocrine and exocrine function was well maintained. Compared to the non-exposed group, MPD ERR group showed increased future worries but comparable function and symptom scales.

Conclusion: While MPD ERR significantly increases the complexity of perioperative management following MIEN, it does not affect long-term metabolic outcomes and patient QoL.

Trial Registration: ClinicalTrials.gov (NCTXXXXXXXX).