Form fields, JavaScript and so forth "float over" the page, so you can replace the contents while keeping them.
No such luck with accessibility. This is part of the page itself, tied to the actual text and contents, and cannot be separated. So you have to redo work if you did it in Acrobat. But
1. You MIGHT be able to replace just changed pages and rework the text order; not clear whether this works properly.
2. If you use PDFMaker you should have the option of making a tagged PDF. This normally needs work but not recreating accessibility from scratch.