An appraisal of radical pancreatoduodenectomy based on insulin secretion

Miyata, Masahiko; Takao, Tetsuto; Okamoto, Eizo; Manabe, Hisao

doi:10.1016/0002-9610(77)90012-5

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…The insulinogenic index, which reflects the total insulin secretion, decreased significantly after surgery. These changes were apparently caused by resection of the caudal portion of the pancreas and were compatible with the changes observed after pancreatoduodenectomy for periampullary cancer [11], This suggests, therefore, that pancreatic endocrine function is impaired by resection of any part of the pancreas. It should be noted, however, that this impaired insulin response after partial pancreatec tomy was observed in patients with a pre-existing disor der of the pancreas.…”

Section: Plasma Insulin Level (supporting

confidence: 76%

“…It is ob vious that insulin secretion from the remaining pancreas progressively decreased after distal pancreatectomy, al though no special therapy was required for these 5 patients. We speculate that chronic destructive changes may continue in the islets of the remaining pancreas, a phenomenon which was observed in postmortem exami nation of long-term survivors after pancreatoduodenec tomy for cancer of the pancreas [11].…”

Section: Plasma Insulin Level (mentioning

confidence: 73%

“…The Discussion Impairment of insulin secretion before surgery, evalu ated by means of two insulinogenic indices, was obvious in our patients. This preoperative impairment was proba bly caused by chronic degenerative changes in the pan creatic islets associated primarily with chronic pancreati tis or secondarily with the pancreatic tumor [10][11][12][13]. The degree of degenerative change in the pancreatic islets var ied with each patient, which may have caused the wide range of impairment of insulin secretion in our patients before surgery.…”

Section: Plasma Insulin Level (mentioning

confidence: 99%

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Influence of Distal Pancreatectomy on Insulin Secretion in Patients with Pre-Existing Disorders of the Pancreas

Miyata¹,

Tanaka²,

Izukura³

et al. 1992

Dig Surg

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Insulin secretion was investigated by oral glucose loading before and early (mean: 8.9 weeks) after distal pancreatectomy (DP) in 9 patients with a tumor of the caudal pancreas. In 6 patients the same investigation was repeated later (mean 17.8 months). Two parameters expressing the initial and total secretion of insulin in response to elevation of the plasma level of glucose ([ΔIRI/ΔBS]_30m and [ΣΔIRI/ΣΔBS]_o-₁₈₀_min) were calculated for each individual patient for serial comparison. These parameters were significantly smaller before the operation compared with 10 normal controls. Early after DP, the parameters decreased significantly, and a further significant decrease was noted late after DP. It is concluded that distal pancreatectomy causes a progressive decrease in insulin secretion in patients with pre-existing disorders of the pancreas.

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Section: Plasma Insulin Level (supporting

confidence: 76%

Section: Plasma Insulin Level (mentioning

confidence: 73%

Section: Plasma Insulin Level (mentioning

confidence: 99%

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Influence of Distal Pancreatectomy on Insulin Secretion in Patients with Pre-Existing Disorders of the Pancreas

Miyata¹,

Tanaka²,

Izukura³

et al. 1992

Dig Surg

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“…Furthermore, while the data indicate that a persistence of insulin and glucagon responsiveness was accompanied by normal fasting glucose levels in these patients, it is unclear whether these patients demonstrated abnormalities or interval changes in overall glucose metabolism. Previous studies have documented that maintenance of fasting euglycemia does not necessarily indicate normal glucose "tolerance" [3,4] and it remains uncertain whether the constancy of the endocrine function examined in these patients was accompanied by a similar stability in glucose homeostasis.…”

Section: Invited Commentarymentioning

confidence: 97%

“…Alterations in metabolic homeostasis may result from changes in the secretion, biological action, and clearance of all 4 islet hormones as well as changes in nutrient absorption, function of other gastrointestinal hormones, and intrinsic changes in metabolic target tissues such as muscle and liver. Continuing an interest in the endocrine responses to pancreatic resection first evidenced 14 years ago [4], Miyata et al have examined the release of insulin and glucagon in response to a standard, if nonphysiologic, provocative stimulus of intravenous arginine infusion. The data indicate that the secretion of insulin and glucagon is severely impaired following pancreatic resection, but that this impairment neither improves nor deteriorates in long-term survivors.…”

Section: Invited Commentarymentioning

confidence: 99%

Pancreatic endocrine functions in long‐term survivors after pancreatoduodenectomy: Special reference to reversibility of insulin and glucagon secretion

et al. 1988

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The number of long‐term survivors of pancreatectomy for cancer is increasing. This study was conducted in patients with periampullary cancer to elucidate the serial change in the pancreatic endocrine functions before and after resection of the head of the pancreas. The pancreatic A and B cell functions were determined by the responses of plasma glucagon and insulin to arginine infusion. For serial comparison, the maximum response and integrated increment of plasma glucagon and insulin were calculated in each patient. There were no significant differences in these parameters between the patients (n=36) before the operation and normal controls (n=18). Early after pancreatoduodenectomy (mean, 6.4 weeks), each parameter was significantly less than its corresponding preoperative value and also less than the value in the normal controls. In the long‐term survivors (mean, 20.1 months after the surgery; n=12) among these 36 patients, these parameters showed no significant changes compared with the early postoperative values and were still significantly less than both the preoperative values and the normal control values. We, thus, conclude that pancreatic A and B cell functions are preserved long‐term after pancreatoduodenectomy in patients with periampullary cancer.

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Pancreatoduodenectomy with occlusion of the residual stump by Neoprene^® injection

et al. 1989

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Pancreatojejunal anastomosis disruption still represents the main postoperative complication after pancreatoduodenectomy. In this study, a technique of occlusion of the residual pancreatic stump instead of pancreatojejunal anastomosis is proposed. Between March, 1981 and August, 1987, we performed 51 pancreatoduodenectomies, using Neoprene injection in the Wirsung duct, for carcinoma of the pancreatic head (28 cases), ampullary carcinoma (12 cases), islet cell carcinoma (5 cases), and chronic pancreatitis (6 cases). We observed a 33.3% overall morbidity, with a 5.8% operative mortality. The complications observed seemed not to be related to the technique of pancreatic stump occlusion, except for 2 pancreatic fistulas which spontaneously resolved. Abdominal ultrasound and computed tomography scan performed during the follow-up did not show any significant morphological alteration of the residual stump. Pancreatic endocrine function was assessed in 10 patients by evaluating blood glucose, plasma insulin and plasma glucagon levels both fasting and after oral glucose, and intravenous arginine infusion. These tests were performed before surgery and 15 days, 6 months, 1, 2, and 3 years after surgery. The results showed that 60% of the patients had impaired glucose tolerance before surgery and the percentage did not significantly change up to 3 years later (75%). No patient developed diabetes mellitus, and only 1 patient progressed from a normal to an impaired glucose tolerance. In conclusion, intraductal injection of Neoprene after pancreatoduodenectomy seems to be a safer procedure compared to pancreatojejunal anastomosis and does not induce a post-surgical diabetes.

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An appraisal of radical pancreatoduodenectomy based on insulin secretion

Cited by 11 publications

References 11 publications

Influence of Distal Pancreatectomy on Insulin Secretion in Patients with Pre-Existing Disorders of the Pancreas

Influence of Distal Pancreatectomy on Insulin Secretion in Patients with Pre-Existing Disorders of the Pancreas

Pancreatic endocrine functions in long‐term survivors after pancreatoduodenectomy: Special reference to reversibility of insulin and glucagon secretion

Pancreatoduodenectomy with occlusion of the residual stump by Neoprene^® injection

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An appraisal of radical pancreatoduodenectomy based on insulin secretion

Cited by 11 publications

References 11 publications

Influence of Distal Pancreatectomy on Insulin Secretion in Patients with Pre-Existing Disorders of the Pancreas

Influence of Distal Pancreatectomy on Insulin Secretion in Patients with Pre-Existing Disorders of the Pancreas

Pancreatic endocrine functions in long‐term survivors after pancreatoduodenectomy: Special reference to reversibility of insulin and glucagon secretion

Pancreatoduodenectomy with occlusion of the residual stump by Neoprene® injection

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Pancreatoduodenectomy with occlusion of the residual stump by Neoprene^® injection