Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy
- 75 Downloads
To identify peri-operative risk factors and time to onset of pancreatic endocrine/exocrine insufficiency.
We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2000 and 2015. Endocrine/exocrine insufficiencies were defined as need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative pancreatic insufficiency.
A total of 1717 patient records were analyzed (75.47% PD, 24.53% DP) at median follow-up 17.88 months. Average age was 62.62 years, 51.78% were male, and surgery was for malignancy in 74.35% of patients. Post-operative endocrine insufficiency was present in 20.15% (n = 346). Male gender (p = 0.015), increased body mass index (BMI) (p < 0.001), tobacco use (p = 0.011), family history of diabetes (DM) (p < 0.001), personal history of DM (p ≤ 0.001), and DP (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 20.80 ± 33.60 (IQR: 0.49–28.37) months. Post-operative exocrine insufficiency was present in 36.23% (n = 622). Race (p = 0.014), lower BMI (p < 0.001), family history of DM (p = 0.007), steatorrhea (p < 0.001), elevated pre-operative bilirubin (p = 0.019), and PD (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 14.20 ± 26.90 (IQR: 0.89–12.69) months.
In this large series of pancreatectomy patients, 20.15% and 36.23% of patients developed post-operative endocrine and exocrine insufficiency at a mean time to onset of 20.80 and 14.20 months, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness long-term.
KeywordsPancreaticoduodenectomy Distal pancreatectomy Pancreatic endocrine insufficiency Pancreatic exocrine insufficiency Pancreatic enzyme replacement
Grant Support and Other Assistance
G.A.W. and J.L. supported by the SPORE grant 5P50CA196510-02. REDCap Supported by Clinical and Translational Science Award (CTSA) Grant [UL1 TR000448] and Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842.
J.K., B.A. participated in study conception and design, analysis, and drafting of the article.
J.L., G.A.W., W.C.C., M.M.B.D., A.S.K., D.E.S., C.W.H., S.M.S., W.G.H. participated in acquisition of data, analysis, and interpretation of data.
R.C.F. participated in study conception and design, acquisition of data, analysis, and interpretation of data, and critical revision of the manuscript.
- 9.Whitcomb DC, Yadav D, Adam S, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, Bishop MD, Baillie J, Sherman S, Disario J, Burton FR, Gardner TB, Amann ST, Gelrud A, Lo SK, DeMeo MT, Steinberg WM, Kockman ML, Etemad B, Forsmark CE, Elinoff B, Greer JB, O’Connell M, Lamb J, Barmada MM. Multicenter approach to recurrent acute and chronic pancreatitis in the United States: The North American Pancreatitis Study 2 (NAPS2). Pancreatology. 2008; 8:520–531.CrossRefGoogle Scholar
- 11.Mantel, N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966;50:163–170.Google Scholar
- 12.Cox, DR. Regression models and life-tables. Journal of the Royal Statistical Society, Series B. 1972;34:187–220.Google Scholar
- 16.Seiler CM, Izbicki J, Vargas-Szabo L, Czak L, Fiok J, Sperti C, Lerch MM, Pezzilli R, Vasileva G, Pap A, Varga M, Friess H. Randomised clinical trial: A 1-week, double-blinded, placebo-controlled study of pancreatin 25 000 Ph. Eur minimicrospheres (Creon 25000 MMS) for pancreatic exocrine insufficiency after pancreatic surgery, with a 1-year open-label extension. Aliment Pharmacol Ther. 2013;37:691–702.CrossRefGoogle Scholar
- 20.White MA, Agle SC, Fuhr HM, Mehaffey JH, Waibel BH, Zervos EE. Impact of pancreatic cancer and subsequent resection on glycemic control in diabeteic and nondiabetic patients. Am Surg. 2011;77:1032–1037.Google Scholar
- 25.Kachare SD, Fitzgerald TL, Schuth O, Vohra NA, Zervos EE. The impact of pancreatic resection on exocrine homeostasis. Am Surg. 2014;80:704–709.Google Scholar
- 31.Wu JM, Ho TW, Kuo TC, Yang CY, Lai HS, Chiang PY, Hsieh SH, Lai F, Tien YW. Glycemic change after pancreaticoduodenectomy: A population-based study. Medicine (Baltimore). 2015l94:e1109.Google Scholar
- 34.Elliott IA, Epelboym I, Winner M, Allendorf JD, Haigh PI. Population-level incidence and predictors of surgically induced diabetes and exocrine insufficiency after partial pancreatic resection. Perm J. 2017; 21:16–095.Google Scholar