Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy

  • Jiro Kusakabe
  • Blaire Anderson
  • Jingxia Liu
  • Gregory A. Williams
  • William C. Chapman
  • Majella M. B. Doyle
  • Adeel S. Khan
  • Dominic E. Sanford
  • Chet W. Hammill
  • Steven M. Strasberg
  • William G. Hawkins
  • Ryan C. FieldsEmail author
Original Article



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.


Pancreaticoduodenectomy 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.

Authors’ Contribution

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.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Jiro Kusakabe
    • 1
  • Blaire Anderson
    • 1
  • Jingxia Liu
    • 1
  • Gregory A. Williams
    • 1
  • William C. Chapman
    • 1
  • Majella M. B. Doyle
    • 1
  • Adeel S. Khan
    • 1
  • Dominic E. Sanford
    • 1
  • Chet W. Hammill
    • 1
  • Steven M. Strasberg
    • 1
  • William G. Hawkins
    • 1
  • Ryan C. Fields
    • 1
    Email author
  1. 1.Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer CenterWashington University School of MedicineSt. LouisUSA

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