Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma

Abstract

Functional and morphological evolution of remnant pancreas after resection for pancreatic adenocarcinoma is investigated.The medical records of 45 patients who had undergone radical resection for pancreatic adenocarcinoma from March 2010 to September 2013 were reviewed retrospectively. There were 34 patients in the pancreaticoduodenectomy (PD) group and 10 patients in the distal pancreatectomy (DP) group. One patient received total pancreatectomy. The endocrine function was measured using the glucose tolerance index (GTI), which was derived by dividing daily maximum serum glucose fluctuation by daily minimum glucose. Remnant pancreas volume (RPV) was estimated by considering pancreas body and tail as a column, and head as an ellipsoid, respectively. The pancreatic atrophic index (PAI) was defined as the ratio of pancreatic duct width to total pancreas width. Representative indices of each patient were compared before and after resection up to 2 years postoperatively.The area under receiver operating characteristic curve of GTI for diagnosing DM was 0.823 (95% confidence interval, 0.699–0.948, P < .001). Overall, GTI increased on postoperative day 1 (POD#1, mean ± standard deviation, 1.79 ± 1.40 vs preoperative, 1.02 ± 1.41; P = .001), and then decreased by day 7 (0.89 ± 1.16 vs POD#1, P < .001). In the PD group, the GTI on POD#14 became lower than preoperative (0.51 ± 0.38 vs 0.96 ± 1.37; P = .03). PAI in the PD group was significantly lower at 1 month postoperatively (0.22 ± 0.12 vs preoperative, 0.38 ± 0.18; P < .001). In the PD group, RPV was significantly lower at 1 month postoperatively (25.3 ± 18.3 cm3 vs preoperative, 32.4 ± 20.1 cm3; P = .02), due to the resolution of pancreatic duct dilatation. RPV of the DP group showed no significant change. GTI was negatively related to RPV preoperatively (r = –0.317, P = .04), but this correlation disappeared postoperatively (r = –0.044, P = .62).Pancreatic endocrine functional deterioration in pancreatic adenocarcinoma patients may in part be due to pancreatic duct obstruction and dilatation caused by the tumor. After resection, this proportion of endocrine insufficiency is corrected.

Investigation of the influence of pancreatic surgery on new‐onset and persistent diabetes mellitus

“…In our study, some patients showed a paradoxical increase in insulin excretion even after pancreatectomy, which was found in patients only after PD. Park et al 26 function in this study, previous reports indicated that fatty infiltration in pancreatic parenchyma 27 or the obstruction of main pancreatic duct would influence endocrine pancreatic function, 26 and these investigations would be a help to develop the prediction tool of NODM. To further validate our findings, we need to prospectively accumulate data on the predictive ability from multiple centers, referring to whether preoperative data predict the development of NODM.…”

“…In our study, some patients showed a paradoxical increase in insulin excretion even after pancreatectomy, which was found in patients only after PD. Park et al 26 reported similar cases, and they assumed that obstructive pancreatitis due to periampullary PDAC exacerbated glucose tolerance by inhibiting insulin secretion, and pancreatectomy for the periampullary tumor sometimes recovered the function in the remnant pancreas by releasing obstruction. In summary, insulin excretion was directly dependent on the resected pancreatic volume in patients undergoing DP, whereas patients undergoing PD did not always correspond to the sole factor of resected pancreatic volume.…”

Diabetes and pancreatic neuroendocrine tumours: Which interplays, if any?

“…Recently, Park et al retrospectively reviewed 45 patients who had undergone radical resection for pancreatic adenocarcinoma: 34 patients underwent pancreaticoduodenectomy, 10 patients distal pancreatectomy, and one received total pancreatectomy. Even if no data about weight loss and malabsorption were reported in their analysis, they found that DM often improved after surgery: diabetes resolution occurred in 20-57% of patients after pancreaticoduodenectomy and in 13% of patients after distal pancreatectomy [65].…”

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

“…In a previous study, the remnant pancreatic volume was found to be a significant risk factor for DM, but this relationship was stronger in patients who underwent DP, rather than PD 16 . Another study showed that obstructive pancreatitis caused by periampullary PDAC exacerbates glucose intolerance by inhibiting insulin secretion and that treatment of the periampullary tumor by pancreatectomy sometimes permits the recovery of the function of the remnant pancreas by removing the obstruction 17 . However, the endocrine function of patients following PD cannot be explained by the remnant pancreas volume alone.…”