Comparative Study Between Conservative Versus Surgical Management of Iatrogenic Pancreatic Injury During Radical Nephrectomy.

Background Pancreatic injury is a rare but serious complication of radical nephrectomy. The best management strategy for this complication, either conservative or surgical, remains debated, with limited comparative data. Objective To compare conservative management (CM) (drain placement, nutritional support, or somatostatin analogs) with surgical management (SM) (direct pancreatic repair, surgical drainage procedures, or partial pancreatectomy) in terms of outcomes, hospital stay, and mortality. Patients and methods A retrospective cohort study was conducted, including 30 patients who underwent radical nephrectomy with intraoperative pancreatic injury from January 2014 to January 2024. Patients were divided into two groups: Group 1, the CM group, which had 16 patients who underwent percutaneous drainage, octreotide, or enteral nutrition, and group 2, the SM group, which had 14 patients who underwent pancreatic repair, resection, or internal drainage. Both groups were compared in terms of complications, hospital stay, and mortality. Results The study groups were comparable regarding baseline patient criteria. Postoperative pancreatic fistula (POPF) was markedly less common in group 2 (14.3%; 2/14) than group 1 (37.5%; 6/16) (p=0.045). Mortality rates did not significantly differ between the trial arms. However, secondary outcomes revealed statistically significant differences between study groups in terms of hospital stay and failure/reintervention rates. Conclusion Surgical repair reduces POPF incidence and hospital stay, but CM is effective in minor injuries. A risk-based approach is recommended.