A Maignan1, M Ouaïssi2, O Turrini3, N Regenet4, A Loundou5, G Louis6, V Moutardier7, L Dahan8, N Pirrò1, B Sastre1, J-R Delpero3, I Sielezneff1. 1. AP-HM, hôpital de la Timone, service de chirurgie digestive et viscérale, 13005 Marseille, France. 2. AP-HM, hôpital de la Timone, service de chirurgie digestive et viscérale, 13005 Marseille, France; CHRU, hôpital de Trousseau, service de chirurgie digestive, oncologique, endocrinienne et de transplantation hépatique, 37170 Chambray-les-Tours, France. Electronic address: m.ouaissi@chu-tours.fr. 3. Institut Paoli-Calmette, service de chirurgie oncologique, 13009 Marseille, France. 4. Hôpital Hôtel-Dieu, service de chirurgie digestive et endocrinienne, 44000 Nantes, France. 5. AP-HM, Aix Marseille université, faculté de médecine de Marseille, service de santé publique et biostatistique, 13005 Marseille, France. 6. AP-HM, hôpital de la Timone, service de radiologie, 13005 Marseille, France. 7. AP-HM, hôpital Nord, service de chirurgie digestive générale, endocrinienne, 13005 Marseille, France. 8. AP-HM, hôpital de la Timone, service d'oncologie digestive, 13005 Marseille, France.
Abstract
Management of functional consequences after pancreatic resection has become a new therapeutic challenge. The goal of our study is to evaluate the risk factors for exocrine (ExoPI) and endocrine (EndoPI) pancreatic insufficiency after pancreatic surgery and to establish a predictive model for their onset. PATIENTS AND METHODS: Between January 1, 2014 and June 19, 2015, 91 consecutive patients undergoing pancreatoduodenectomy (PD) or left pancreatectomy (LP) (72% and 28%, respectively) were followed prospectively. ExoPI was defined as fecal elastase content<200μg per gram of feces while EndoPI was defined as fasting glucose>126mg/dL or aggravation of preexisting diabetes. The volume of residual pancreas was measured according to the same principles as liver volumetry. RESULTS: The ExoPI and EndoPI rates at 6 months were 75.9% and 30.8%, respectively. The rate of ExoPI after PD was statistically significantly higher than after LP (98% vs. 21%; P<0.001), while the rate of EndoPI was lower after PD vs. LP, but this difference did not reach statistical significance (28% vs. 38.5%; P=0.412). There was no statistically significant difference in ExoPI found between pancreatico-gastrostomy (PG) and pancreatico-jejunostomy (PJ) (100% vs. 98%; P=1.000). Remnant pancreatic volume less than 39.5% was predictive of ExoPI. CONCLUSION: ExoPI occurs quasi-systematically after PD irrespective of the reconstruction scheme. The rate of EndoPI did not differ between PD and LP.
Management of functional consequences after pancreatic resection has become a new therapeutic challenge. The goal of our study is to evaluate the risk factors for exocrine (ExoPI) and endocrine (EndoPI) pancreatic insufficiency after pancreatic surgery and to establish a predictive model for their onset. PATIENTS AND METHODS: Between January 1, 2014 and June 19, 2015, 91 consecutive patients undergoing pancreatoduodenectomy (PD) or left pancreatectomy (LP) (72% and 28%, respectively) were followed prospectively. ExoPI was defined as fecal elastase content<200μg per gram of feces while EndoPI was defined as fasting glucose>126mg/dL or aggravation of preexisting diabetes. The volume of residual pancreas was measured according to the same principles as liver volumetry. RESULTS: The ExoPI and EndoPI rates at 6 months were 75.9% and 30.8%, respectively. The rate of ExoPI after PD was statistically significantly higher than after LP (98% vs. 21%; P<0.001), while the rate of EndoPI was lower after PD vs. LP, but this difference did not reach statistical significance (28% vs. 38.5%; P=0.412). There was no statistically significant difference in ExoPI found between pancreatico-gastrostomy (PG) and pancreatico-jejunostomy (PJ) (100% vs. 98%; P=1.000). Remnant pancreatic volume less than 39.5% was predictive of ExoPI. CONCLUSION: ExoPI occurs quasi-systematically after PD irrespective of the reconstruction scheme. The rate of EndoPI did not differ between PD and LP.
Authors: Mary Ellen Vajravelu; Jung-Jin Lee; Lauren Mitteer; Babette S Zemel; Kyle Bittinger; Diva D De León Journal: Pancreas Date: 2021-01-01 Impact factor: 3.243