Pylorus-preservation decreases the extent of atrophy of the remnant pancreas after pancreatoduodenectomy

Abstract

Background Pylorus-preserving pancreatoduodenectomy (PPPD) preserves the secretion of gastrointestinal (GI) hormones from the distal stomach and duodenum, whereas after pancreatoduodenectomy (PD) they are no longer secreted. It has been suggested that some GI hormones exert a trophic effect on the pancreas, although this effect has not been documented in man. It was postulated that the ablation of GI hormones, such as gastrin and cholecystokinin (CCK), by PD is an important cause of postoperative pancreatic atrophy and, since PPPD preserves the secretion of these hormones, it would be more effective than PD for the maintenance of postoperative pancreatic function. Our study aimed to determine whether pylorus preservation after PD affects the volume of the remnant pancreas in long-term survivors and whether any such effect is related to the continued secretion of GI hormones following preservation of the pylorus. Methods We measured postoperative pancreatic volume and the release of gastrin and CCK in patients who underwent PD or PPPD performed by the same surgeon and who had survived ≥ 1 year without tumour recurrence. For volumetry, thin-section spiral CT with 3D display was performed; hormone release was measured by radioimuno-assay using antibodies. Results After PPPD, pancreatic volume and gastrin and CCK release were significantly greater than after PD; there was a significant correlation between pancreatic volume and stimulated gastrin release. Pancreatic volume was not related to other clinical factors, such as type of reconstruction, age, postoperative interval, or nutritional status. Discussion The volume of distal remnant pancreas is greater after PPPD than after PD and this difference may reflect preservation (by PPPD) of GI hormones that exert a trophic effect on the pancreas.