Impact of pancreatic transection level on survival outcomes and glycemic control following distal pancreatectomy for pancreatic tail cancer: A multicenter cohort study

Background: The optimal transection level (TL) during distal pancreatectomy (DP) for pancreatic tail cancer remains unclear. This study evaluated the effect of TL on survival and glucose metabolism. Methods: We retrospectively reviewed 320 patients undergoing DP between 2000 and 2018 at three centers. Patients were grouped as proximal transection (PT, n = 264) or distal transection (DT, n = 56) relative to the aorta. Perioperative, oncologic, and metabolic outcomes were compared, including a propensity score–matched analysis. Results: Operation time and blood loss were greater in PT, which also yielded more lymph nodes (14 vs. 10, P < 0.01), though R0 resection and nodal positivity were similar. In the matched cohort, disease-free survival (17.7 vs. 15.3 months, P = 0.76) and overall survival (27.0 vs. 30.9 months, P = 0.64) did not differ between PT and DT. Multivariable analysis confirmed no association of TL with survival. Among non-diabetic patients, PT was associated with a greater rise in HbA1c at 1 year (0.57 % vs. 0.16 %; P = 0.056), suggesting impaired glycemic control. Conclusions: Transection level does not influence oncologic outcomes in DP for pancreatic tail cancer but may affect postoperative glucose regulation.