Relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases

Kan Wen,Hongli Yang,Chunyuan Cen,Yu Zhang,Guina Ma,Leidi Wu,Ping Han,Xiaofei Yue,Mengting Huang,Xin Li

doi:10.1007/s00261-021-03061-4

Abstract

ObjectiveTo evaluate the relationship between pancreatic parenchyma loss and early postoperative hyperglycemia in patients with benign pancreatic diseases.MethodsA total of 171 patients with benign pancreatic tumors or chronic pancreatitis, whose preoperative fasting blood glucose (FBG) was normal and who underwent partial pancreatectomy were reviewed. The pancreatic volume was measured by CT imaging before and after the operation. According to their different pancreatic resection volume (PRV), 171 patients were divided into five groups: < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%. The correlation between the PRV and postoperative FBG was investigated. According to the postoperative FBG value, the patients were divided into a hyperglycemia group (HG) and nonhyperglycemia group (non-HG) to explore the best cutoff value of the PRV between the two groups.ResultsThere were significant differences in the postoperative FBG among the five groups (PRV < 30%, 30%–39%, 40%–49%, 50%–59%, and ≥ 60%). The PRV was positively correlated with postoperative FBG in the benign tumor group and chronic pancreatitis group (R = 0.727 and 0.651, respectively). ROC curve analysis showed that the best cutoff value of the PRV between the HG (n = 84) and non-HG (n = 87) was 39.95% with an AUC = 0.898; the sensitivity was 89.29%, and the specificity was 82.76%.ConclusionThere was a linear positive correlation between the postoperative FBG level and PRV. Patients with a PRV ≥ 40% are more likely to develop early postoperative hyperglycemia.

Highlights

In recent years, the number of surgeries for benign pancreatic diseases has increased rapidly [1, 2]
There was no significant difference in preoperative fasting blood glucose (FBG) between the benign pancreatic tumor group and the chronic pancreatitis group (P = 0.162)
There was a significant difference in postoperative FBG between the benign pancreatic tumor group and the chronic pancreatitis group (P = 0.010)

Summary

Introduction

The number of surgeries for benign pancreatic diseases has increased rapidly [1, 2]. The increased use of imaging modalities such as CT and MRI has led to an increase in the number of benign pancreatic tumors incidentally diagnosed [3, 4]. Loss of the pancreatic parenchyma directly leads to decreases in the numbers of multiple endocrine cells (alpha cells, beta cells, gamma cells, and PP cells) and affects the secretion of hormones such as insulin, glucagon,. Abdominal Radiology (2021) 46:4210–4217 somatostatin, and pancreatic polypeptides, affecting the regulation of blood glucose by the pancreas [7]. The mechanism of endocrine insufficiency after pancreatic surgery has not been thoroughly studied, especially with regard to the relationship between quantitative pancreatic parenchyma loss and postoperative fasting blood glucose (FBG). Maignan A et al, Kwon JH et al, and Singh AN et al believe that pancreatic parenchyma loss is a risk factor for postoperative hyperglycemia [9,10,11].King J et al stated that retaining 20% to 25% of the pancreatic parenchyma can maintain pancreatic function [12], and surgical resection of portions of the pancreatic parenchyma will not affect endocrine function

Methods

Results

Conclusion