# Clinical Influence of Bile Duct and Duodenum Preservation on Zinc Absorption and Remnant Pancreatic Volume in Duodenum-Preserving Pancreatic Head Resection for Low-Grade Malignant Pancreatic Tumors

## TL;DR

This study shows that preserving the duodenum during pancreatic surgery helps maintain pancreatic volume and improves zinc levels, supporting better nutrition after surgery.

## Contribution

The study is the first to compare postoperative pancreatic volume and zinc levels between DPPHR and PD in low-grade pancreatic malignancies.

## Key findings

- DPPHR preserved remnant pancreatic volume better than PD at both postoperative day 7 and 1 year.
- DPPHR patients had significantly higher serum zinc levels at 1 year compared to PD patients.
- DPPHR showed better maintenance of serum albumin levels at 1 year post-surgery.

## Abstract

This retrospective study investigates the effects of duodenum-preserving pancreatic head resection (DPPHR) versus pancreaticoduodenectomy (PD) on postoperative pancreatic volume and nutritional parameters in patients with low-grade pancreatic malignancies. A total of 41 patients were analyzed, including 23 who underwent DPPHR and 18 who received PD. Postoperative pancreatic volume was measured using computed tomography on postoperative day 7 and at 1 year. Serum zinc and albumin levels, along with prognostic nutritional index (PNI), were also evaluated. The DPPHR group showed significantly better maintenance of remnant pancreatic volume at both time points compared to the PD group. Additionally, serum zinc and albumin levels were significantly higher in the DPPHR group at 1 year postoperatively. No significant difference in the PNI was observed. These findings suggest that DPPHR is advantageous in maintaining pancreatic tissue and supporting nutritional status after surgery, possibly due to preservation of the duodenum, which plays a key role in zinc absorption and digestive hormone regulation. This study emphasizes the functional and nutritional benefits of DPPHR compared to PD. Future prospective studies with larger cohorts and detailed functional assessments are necessary to validate these findings and explore their implications for long-term patient outcomes and quality of life.

Background/Objectives: Duodenum-preserving pancreatic head resection (DPPHR) preserves digestive and absorptive functions better than pancreaticoduodenectomy (PD). Zinc is primarily absorbed in the duodenum and proximal jejunum and plays a critical role in nutritional maintenance and pancreatic regeneration. However, no studies have compared the postoperative pancreatic volume and serum zinc levels between DPPHR and PD. Methods: We retrospectively analyzed 41 patients who underwent DPPHR (n = 23) or subtotal stomach-preserving PD (n = 18) for low-grade pancreatic malignancies at our institution. The remnant pancreatic volumes on postoperative day 7 and 1 year were measured via computed tomography. Nutritional parameters, including serum albumin, prognostic nutritional index (PNI), and serum zinc levels, were compared between the groups. Serum zinc levels were evaluated in patients with DPPHR (n = 11) or PD (n = 7). Results: The DPPHR group demonstrated significantly better preservation of remnant pancreatic volume on postoperative day 7 and 1 year compared to the PD group (p = 0.045 and p = 0.041, respectively). Volume maintenance ratios were also significantly higher in the DPPHR group. Serum albumin levels at 1 year postoperatively were significantly better in the DPPHR group, although no significant difference was found in the PNI. Among patients evaluated for serum zinc, the DPPHR group showed significantly higher zinc levels compared to the PD group (80.3 vs. 65.8 μg/dL, p = 0.017). Conclusions: DPPHR preserves remnant pancreatic volume and maintains serum zinc levels better than PD, potentially contributing to improved postoperative nutritional status and quality of life. Further prospective studies with larger cohorts are warranted to validate these findings.