Digestive function after radical pancreaticoduodenectomy

Abstract

Forty-nine patients have had pancreaticoduodenectomy performed for periampullary carcinoma at the University of Texas Medical Branch Hospitals. Ten of these patients are currently alive. Six patients surviving from twenty to eighty-four months were studied to determine the degree of residual pancreatic function. Half of the patients were unable to regain their weight or resume their previous occupations. All the patients had an increased number of stools per day (three to twelve) and were receiving a small amount of pancreatic enzyme supplementation. Five of the six patients had abnormal amounts of fecal fat and three of them had an elevated fecal nitrogen excretion. A diabetic glucose tolerance curve was found in all six patients, but no treatment other than diet was required. Serum albumin, total exchangeable albumin, and albumin halflife was decreased in all patients. Liver biopsy revealed changes of fatty infiltration in three of four patients. Subjective and objective improvement was obtained by instituting adequate doses of oral pancreatic enzymes. In nine dogs elevated fecal fats and nitrogens as well as diabetic glucose tolerance curves were found after resection and implantation of the distal pancreas. At sacrifice, pancreatic atrophy was found secondary to stricture of the pancreatic duct at the site of implantation. Obstruction of the pancreatic duct followed by resection and implantation of a pancreatic remnant did not influence the subsequent results. It is concluded that implantation of the stump of residual pancreas into the bowel leads to stricture of the pancreatic duct, parenchymal atrophy, and functional insufficiency. The loss of digestive enzymes may prevent the full rehabilitation of the patients. Pancreatic enzyme supplementation in adequate dosage is useful in overcoming this deficit.