Comparative long-term outcomes for pancreatic volume change, nutritional status, and incidence of new-onset diabetes between pancreatogastrostomy and pancreatojejunostomy after pancreaticoduodenectomy

Abstract

Background: The difference in volume change in a pancreatic remnant according to the type of pancreaticoenterostomy after pancreaticoduodenectomy (PD) for long-term follow-up is unknown. Also, there are few studies that evaluate the difference in general nutritional status and pancreatic endocrine function, including new-onset diabetes mellitus (NODM) depending on the type of pancreaticoenterostomy.This study aimed to compare serial pancreatic volume changes in pancreatic remnants between pancreatogastrostomy (PG) and pancreatojejunostomy (PJ) after PD and to evaluate the difference in general nutritional status and incidence of NODM between PG and PJ.Methods: This study enrolled 115 patients who had survived for more than 3 years after PD. They were divided into the PG group and the PJ group. Their clinicopathologic factors were collected and analyzed. We calculated serial pancreas volume and pancreatic duct size precisely from preoperative stage to 5 years after surgery by image-processing software specifically designed for navigation and visualization of multimodality and multidimensional images. Consecutive changes of albumin and body mass index (BMI) as related to general nutritional status were compared between the PG and PJ groups. To evaluate the incidence and risk factors of NODM following PD, subgroup analysis was performed in 88 patients who did not have diabetes preoperatively.Results: Most patient demographics were not significantly different between the PG group (n=45) and PJ group (n=70). There was no significant difference in volume reduction between the groups from postoperative 1 month to 5 years (PG group −18.21±14.66 mL versus PJ group −14.43±13.05 mL, P=0.209).But there was a significant difference in increased pancreatic duct size between the groups from postoperative 1 month to 5 years (PG group 1.66±2.20 mm versus PJ group 0.54±1.54 mm, P=0.007). There was no significant difference in the increase of total serum albumin between the groups for 5 years after surgery (PG group 0.51±0.47 g/dL, 14.3% versus PJ group 0.42±0.60 g/dL, 11.3%, P=0.437). There was also no significant difference in BMI decrease between the groups (PG group −1.13±3.12, −4.9% versus PJ group −1.97±2.01, −8.7%, P=0.206). On the whole, NODM was diagnosed in 19 patients out of the 88 patients (21.6%) who did not have DM preoperatively. The incidence of NODM was not significantly different between the groups (PG group 21.6% versus PJ group 21.5%, P=0.995). In addition, pancreaticoenterostomy was not an independent risk factor for NODM by logistic regression analysis (odds ratio, 0.997, 95% CI: 0.356-0.2.788, P=0.995). No other risk factors for NODM were found.Conclusions: PG and PJ following PD induced similar pancreatic volume reduction during long-term followup. There was no difference in general nutritional status or incidence of NODM between the groups after PD.

Three-Year Observation of Glucose Metabolism After Pancreaticoduodenectomy: A Single-Center Prospective Study in Japan

“…Several clinical studies have examined the incidence of diabetes after PD, and the incidence rates for these studies are reported as 10% to 30% ( 10 , 14–18 ). In this study, the incidence of diabetes was 53.8% at 36 months postoperatively, as shown in Fig.…”

“…The second reason may be due to differences in the way diabetes was diagnosed. We used the 75-g OGTT, HbA1c, and FBG to diagnose diabetes; however, almost all reported studies have used only HbA1c and FBG ( 10 , 14–17 ). As shown in Fig.…”

“…Among the types of pancreatectomies, pancreaticoduodenectomy (PD) causes considerable changes in postoperative glucose tolerance and nutritional status of patients because it involves resection of the duodenum, part of the stomach, bile duct, and gallbladder, as well as the pancreatic head, and it requires gastrointestinal reconstruction after resection ( 9–13 ). However, there are inconsistent reports on glucose tolerance, especially the incidence of diabetes, depending on whether the study is prospective or retrospective, the observation period, the method of diabetes diagnosis, and the race of patients included ( 10 , 14–18 ). In addition, risk factors for diabetes after PD are not yet established, except for the possible contribution of atrophy of the remaining pancreas ( 15 ) and a glycated hemoglobin (HbA1c) level of ≥ 5.4% ( 16 ).…”

Comparison of early postoperative outcomes between omega-like duct-to-mucosa pancreatojejunostomy and conventional duct-to-mucosa pancreatojejunostomy after pancreaticoduodenectomy

“…[29][30][31] However again, reports have been conflicting; other studies have concluded that pancreatogastrostomy and pancreatojejunostomy following pancreatoduodenectomy induced a similar reduction of pancreatic volume, and made no difference to general nutritional status or the incidence of new-onset diabetes mellitus (NODM). 32 No single technical variation of the pancreaticojejunal or pancreaticogastric anastomosis has been found consistently to be superior to another. However, pancreatojejunostomy may lead to a more preferable physiological structure.…”

Functional outcomes of pancreaticoduodenoctomy

“…При этом частота стеатореи достоверно не отличалась. Также не отмечено различий в уровне сывороточного альбумина и индексе массы тела (ИМТ) [42].…”