Pancreatic Regeneration and Changes in Endocrine Function after Pancreatectomy

Abstract

Background: Limited evidence is available on the regeneration of and functional changes to remnant pancreas after pancreatectomy. Therefore, we investigated the correlation between changes in volume and endocrine function in the remnant pancreas. Methods: Ninety patients undergoing pancreaticoduodenectomy (PD) and 45 undergoing distal pancreatectomy (DP) from January 2009 to December 2017 were included in this prospective study. Computed tomography was used to determine the volume of remnant pancreas 3 months, 1 year, and 2 years after pancreatectomy. Findings: The remnant pancreas volume compared to the initial residual pancreas was 80·79%, 68·67%, and 65·34% in the PD patients (p<0·001), and 106·25%, 106·62%, and 110·43% (p=0·019) in the DP patients at 3 months, 1 year, and 2 years, respectively. The DP patients had a higher incidence of new-onset diabetes than PD patients (33·3% vs. 22·7%). In addition, PD patients had more pancreatic duct dilatation with severe atrophy of the remnant pancreas (p=0·027), whereas DP patients had better pancreas regeneration (p=0·084) with spleen preservation. The changes in pancreas volume did not correlate with postoperative new-onset diabetes. Interestingly, the PD group had significantly greater restoration of endocrine function based on secretion of C-peptide. Interpretation: Pancreatic regeneration is more predominant after DP than PD. The distal portion of the pancreas had greater restoration capacity, corresponding with a lower rate of new-onset diabetes. Funding Statement: The study was supported by Taiwan Ministry of Science and Technology (MOST108-2321-B-006-014), Ministry of Health and Welfare (MOHW 107-TDU-B-212-114026A), and HSU-YUAN Education Foundation (HY-2018-001). Declaration of Interests: The authors reported no conflict of interest. Ethics Approval Statement: IRB approved by the Institutional Review Board of the National Cheng Kung University Hospital (approval number of B-ER-108-312).