Clinical Implications and Risk Factors of Dilatation of Remnant Pancreatic Duct at 1 Year After Pancreatoduodenectomy: A Prospective, Japanese, Multicenter, Observational Cohort Study (DAIMONJI-Study).

Abstract

To determine the precise frequency of main pancreatic duct (MPD) dilatation within the remnant pancreas at 1 year after pancreatoduodenectomy (PD) and its clinical implications, a prospective multicentre cohort study was performed in patients without MPD dilatation before PD (Registry number; UMIN000029662). Between October 2017 and July 2020, patients with MPD diameter <3mm who were planned to undergo PD for periampullary lesions at 21 hospitals were enrolled. The primary endpoints were frequency of MPD dilatation at 1 year after PD, and the relationship between MPD dilatation and pancreatic endo- and exocrine function, nutritional status, and fatty liver. Secondary endpoints were risk factors for MPD dilatation at 1 year after PD and time-course change in MPD diameter. Of 200 registered patients, 161 patients were finally analyzed. Pancreatic fistula was the most frequent complication (n=76; 47.2%). MPD dilatation (MPD>3mm) at 1 year after PD was seen in 35 patients (21.7%). Pancreatic exocrine function, assessed by steatorrhea, was significantly impaired in patients with MPD dilatation. However, endocrine function, nutrition status and fatty liver development were comparable between the two groups. In multivariate analysis, the serum toral protein level≥7.3g/dl was an independent predictor for MPD dilatation at 1 year after PD (OR; 3.12, 95%CI; 1.31-7.15). A mean MPD diameter significantly increased at 6 months after PD and kept plateau thereafter. MPD dilatation at 1 year after PD was seen in 21.7% of patients and significantly associated with exocrine function impairment but not with endocrine function, nutrition status, or development of fatty liver.