Clinical and metabolic response to radical distal pancreatectomy for chronic pancreatitis

Abstract

A 95 per cent distal resection of the pancreas has been performed in five patients who had severe chronic debilitating pancreatitis. The clinical results have been good with objective improvement documented by diminution in frequency and duration of hospital stay, lowered analgesic requirement, appetite return, and marked weight gain. Preoperative exocrine insufficiency was present in every case and was made markedly worse by pancreatic resection. Metabolic studies prior to the institution of enzyme therapy revealed a 76 per cent increase in excretion of fecal fat. With carefully planned supplemental pancreatic enzyme therapy, the loss of fat in the stool was decreased to levels lower than those present prior to pancreatic resection. All patients had diabetes prior to pancreatectomy which continued in the postpancreatectomized state. Fasting insulin levels were normal in two and elevated in three of five patients. After an oral glucose tolerance test, the expected rise in plasma insulin levels did not occur in a single instance. Attempts to stimulate endogenous insulin secretion by the intravenous administration of tolbutamide were likewise unsuccessful except in one patient in whom the adequacy of pancreatic resection could not be established adequately. One patient, who had marked diabetes prior to pancreatectomy, revealed a greatly elevated fasting serum insulin level despite excision of all but a tiny remnant of pancreas. In general, postoperative insulin requirements were markedly reduced during the early weeks of the postoperative course. However, with the institution of adequate supplemental pancreatic enzyme therapy, decreased fecal fat loss, and weight gain, the insulin requirements increased and became essentially equal to the preoperative requirements in three of five patients. Although two had diabetic acidosis prior to pancreatectomy, none has been admitted with this complication after pancreatic resection.