Postoperative Pancreatic Function Research Articles

Middle-segment preserving pancreatectomy: a literature review and case report.

Middle segment-preserving pancreatectomy (MSPP) is a relatively new parenchymal-sparing surgery that has been introduced as an alternative to total pancreatectomy (TP) for multicentric benign and borderline pancreatic diseases. To date, only 36 cases have been reported in English. We reviewed 22 published articles on MSPP and reported an additional case. Our patient was a 49-year-old Japanese man diagnosed with Zollinger-Elison syndrome (ZES) caused by duodenal and pancreatic gastrinoma associated with multiple endocrine neoplasia syndrome type 1. We avoided TP and chose MSPP as the operative technique due to his relatively young age. The patient developed a grade B postoperative pancreatic fistula (POPF), which improved with conservative treatment. He was discharged without further treatment. To date, no tumor has recurred, and pancreatic function seems to be maintained. According to a literature review, the morbidity rate of MSPP is as high as 54%, mainly due to the high incidence of POPF (32%). In contrast, there was no perioperative mortality, and postoperative pancreatic function was comparable to that after conventional pancreatectomy. Despite the high incidence of POPF, MSPP appears to be safe, with low perioperative mortality and good postoperative pancreatic sufficiency.

Dynamics of perioperative pancreatic exocrine function in patients undergoing reconstruction after gastrectomy for gastric cancer.

Each method of reconstruction after gastrectomy results in a change in the digestive and absorptive status. However, there are few reports on the changes in pancreatic exocrine function after gastrectomy. We conducted this study to investigate the dynamics of pancreatic exocrine function after gastrectomy according to the method of reconstruction performed. The subjects of this study were 45 patients who underwent pancreatic exocrine function tests preoperatively and postoperatively, from among all patients who underwent gastrectomy for gastric cancer at our hospital between September, 2020 and March, 2022. We assessed pancreatic exocrine function using the Pancreatic Function Diagnostant (PFD) test. The mean preoperative PFD test result values for the distal gastrectomy (DG) Billroth I reconstruction (B-I) group and the DG Roux-en-Y reconstruction (R-Y) group were 62.6 and 67.3 (p = 0.36), respectively, and the mean postoperative PFD test result values for each group were 65.8 and 46.9 (p = 0.0094), respectively. A significant decrease in postoperative pancreatic function was observed in the DG R-Y group but not in the DG B-I group. The logistic regression analysis identified that age and the R-Y group were significantly correlated with a 10% decrease in the PFD value after gastrectomy. Our study suggests that R-Y reconstruction may result in more impaired pancreatic exocrine function than B-I reconstruction.

Robotic central pancreatectomy: a systematic review and meta-analysis.

Central pancreatectomy is usually performed to excise lesions of the neck or proximal body of the pancreas. In the last decade, thanks to the advent of novel technologies, surgeons have started to perform this procedure robotically. This review aims to appraise the results and outcomes of robotic central pancreatectomies (RCP) through a systematic review and meta-analysis. A systematic search of MEDLINE, Embase, and Web Of Science identified studies reporting outcomes of RCP. Pooled prevalence rates of postoperative complications and mortality were computed using random-effect modelling. Thirteen series involving 265 patients were included. In all cases but one, RCP was performed to excise benign or low-grade tumours. Clinically relevant post-operative pancreatic fistula (POPF) occurred in 42.3% of patients. While overall complications were reported in 57.5% of patients, only 9.4% had a Clavien-Dindo score≥III. Re-operation was necessary in 0.7% of the patients. New-onset diabetes occurred postoperatively in 0.3% of patients and negligible mortality and open conversion rates were observed. RCP is safe and associated with low perioperative mortality and well preserved postoperative pancreatic function, although burdened by high overall morbidity and POPF rates.

Investigation of the influence of pancreatic surgery on new-onset and persistent diabetes mellitus.

AimThe management of diabetes mellitus (DM) after pancreatic surgery is a long‐standing issue. We aimed to investigate DM concerning pancreatic surgery, including new onset diabetes mellitus (NODM), DM resolution, and the change in insulin excretion before/after pancreatic surgery.MethodsWe retrospectively investigated three different cohorts (total 403 patients) undergoing pancreatectomy. Of those, 275 patients without preoperative DM were investigated for the risk factors of NODM. Fifty‐four patients without preoperative DM of the other cohort were assessed for pre/postoperative 24‐hour urinary C‐peptide excretion (24‐hr CPR). To evaluate the influence of pancreatic surgery on DM treatment in patients with preoperative DM, 74 patients were investigated. In all those patients, the pancreatic volume in pre/postoperative images was assessed to estimate the resected pancreatic volume.ResultsNODM was observed in 60 patients (21%), and a lower ratio of remnant pancreatic volume (RRPV) was the only significant risk factor for NODM. Postoperative 24‐hr CPR was significantly associated with two factors, RRPV and preoperative 24‐hr CPR. Nine of 74 patients with preoperative DM achieved DM resolution after pancreatic surgery, and the presence of gastrointestinal anastomosis was a significant preferable factor for DM resolution.ConclusionsConsidering the management of DM after surgery, both predicting the postoperative pancreatic volume and the presence of gastrointestinal reconstruction are significant. We concluded that the combined assessment of the predicted remnant pancreatic volume and the preoperative 24‐hr CPR value is useful to predict the postoperative pancreatic function.

Overall Postoperative Morbidity and Pancreatic Fistula Are Relatively Higher after Central Pancreatectomy than Distal Pancreatic Resection: A Systematic Review and Meta-Analysis.

Objective To compare the intraoperative and postoperative outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). Methods A systematic literature search was performed on electronic databases from MEDLINE, Embase, and PubMed from 1998 to 2018. Statistical analysis and meta-analysis were performed using statistics/data analysis (Stata®) software, version 12.0 (StataCorp LP, College Station, Texas 77845, USA). Dichotomous variables were analyzed by estimation of relative risk (RR) with a 95 percent (%) confidence interval (CI) and continuous variables were analyzed by standardized mean differences (SMD) with 95% CI. Results Twenty-four studies with 593 CP and 1226 DP were included in the meta-analysis. CP had significantly longer operation time (SMD: 1.03; 95% CI 0.62 to 1.44; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.001) and lengthier postoperative hospital stay (SMD: 0.63; 95% CI 0.20 to 1.05; P < 0.01). Estimated blood loss was significantly lower in CP (SMD: −0.34; 95% CI −0.58 to −0.09; P = 0.007). Overall postoperative morbidity (RR: 1.30; 95% CI: 1.13 to 1.50; P < 0.001), overall pancreatic fistula (RR: 1.41; 95% CI: 1.20 to 1.66; P < 0.001), clinically relevant fistula (RR: 1.64; 95% CI: 1.25 to 2.16; P < 0.001), and postoperative hemorrhage (RR: 1.90; 95% CI: 1.18 to 3.06; P < 0.05) were all significantly higher after CP. On long-term follow-up, DP patients were more likely to have postoperative exocrine (RR: 0.56; 95% CI: 0.37 to 0.84; P < 0.05) and endocrine (RR: 0.27; 95% CI: 0.18 to 0.40; P < 0.001) insufficiency. There was no statistically significant difference in transfusion requirement, postoperative mortality, reoperation, and tumor recurrence. Conclusion CP is associated with significantly higher morbidity and clinically relevant pancreatic fistula. CP should only be reserved for selected patients who require postoperative pancreatic function preservation.

Amount of resectable pancreatic cancer and postoperative pancreatic function

To understand the physiological response of sea cucumber, Apostichopus japonicas, were exposed to different concentration of benzo[a]pyrene (B[a]P), and the growth, survival, antioxidant enzyme (SOD and T-AOC) activities were tested. Meanwhile, the quantitative real-time PCR technology was utilized to quantize the expression of immune related genes (i.e. innate immune genes, HSP genes and anti-oxidative genes). In our result, the SOD activity and T-AOC activity were induced at lower level of B[a]P (0.03 μg/L), however, a reduction of SOD activity and T-AOC activity were observed at relatively high B[a]P concentration (3 and 9 μg/L) for A. japonicas. Furthermore, the distinct expression patterns of selected immune-related genes were detected among different concentrations, and a general trend of down-regulation was observed at higher concentration. Especially, lysozyme almost showed the highest down-regulation at all concentrations, followed by NOS. Collectively, the growth, survival and expression signatures of immune related genes reflected an overall suppression of innate immunity in sea cucumber following exposure. Future functional studies should be carried out to characterize the detailed roles of immune genes and their related responses under B[a]P toxicity. Additionally, better understanding of the molecular indicators governing the healthy status under environmental toxicity would facilitate a healthy and sustainable culture program.

The Evaluation of the Early and Late Postoperative Pancreatic Function and Nutritional Status: Central Pancreatectomy Versus Distal Pancreatectomy

The Evaluation of the Early and Late Postoperative Pancreatic Function and Nutritional Status: Central Pancreatectomy Versus Distal Pancreatectomy

Surgical outcomes of pancreaticoduodenectomy in young patients: A case series

BackgroundPancreaticoduodenectomy (PD) is a complex procedure for management periampullary neoplasms The aim of our work is to report the surgical outcomes after PD in young adult (YA) (<35 years) and to compare it to a adult patients who underwent PD. MethodsWe retrospectively analyzed the data of all patients who underwent PD in the period from January 1993 to December 2016. The primary outcome was the rate of total postoperative complications. Secondary outcomes included postoperative pathology, exocrine and endocrine function and survival rate. Results58/975 patients (5.9%) were YA and the majority of them were females. The incidence of post-operative complications in the YA was comparable to that in the adult group. Delayed gastric emptying developed significantly in adult group than YA group (0.008). The overall survival was significantly higher in the YA (P = 0.0001). The most common pathology in the YA was adenocarcinoma (41.4%) and solid pseudopapillary tumor (SPT) (29.3%). No significant difference as regards postoperative pancreatic exocrine and endocrine function in both groups. ConclusionPD in YA when performed in tertiary centers with good surgical experience is safe. The most common pathological diagnosis in the YA was adenocarcinoma followed by SPT.

Parenchyma-Sparing Pancreatectomies for Pancreatic Neuroendocrine Tumors

Parenchyma-sparing pancreatectomy, including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection (pancreaticoduodenectomy or left/distal pancreatectomy) for pancreatic neuroendocrine tumor (PNET). In selected patients, with small (&lt;2 cm) and low-grade tumors, PSP are associated with excellent both overall and disease-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent long-term postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated PNET.

Meta-analysis of surgical outcome after enucleation versus standard resection for pancreatic neoplasms.

Pancreatic enucleation is a tissue-sparing approach to pancreatic neoplasms and may result in better postoperative pancreatic function than standard pancreatic resection. The objective of this review was to compare the postoperative outcome after pancreatic enucleation versus standard resection. MEDLINE, Embase and the Cochrane Library were searched systematically until February 2015 to identify studies comparing the outcome of enucleation versus standard resection for pancreatic neoplasms. After critical appraisal, meta-analysis was performed and the findings were presented as odds ratios or weighted mean differences with corresponding 95 per cent c.i. Twenty-two observational studies (1148 patients) were included. Duration of surgery (P < 0.001), blood loss (P < 0.001), length of hospital stay (P = 0.04), and postoperative endocrine (P < 0.001) and exocrine (P = 0.01) insufficiency were lower after enucleation than after standard resection. Mortality (P = 0.44), overall complications (P = 0.74), reoperation rate (P = 0.93) and delayed gastric emptying (P = 0.15) were not significantly different between the two approaches. The overall rate of postoperative pancreatic fistula (POPF) was higher after enucleation than after standard resection (P < 0.001). However, the raised POPF rate did not result in higher mortality or overall morbidity. Sensitivity analysis of high-volume studies (total of more than 20 enucleations and more than 4 per year) showed that, in specialized centres, enucleation can be performed with no increased risk of POPF (P = 0.12). Compared with standard resection, pancreatic enucleation can be performed effectively and with comparable safety in high-volume institutions. Enucleation should be considered instead of standard resection for selected pancreatic neoplasms.

Central pancreatectomy: 129 patients treated in two European pancreatic centers

Introduction: Central pancreatectomy (CP) is a parenchima-sparing surgical procedure to remove benign and/or low grade malignant lesions from the neck/body of the pancreas. Aims: We reported the experience of two high-volume pancreatic centers (Padua and Heidelberg), regarding indications, postoperative outcome and follow up (FU) of 129 patients submitted to CP in the last 14 years. Patients & methods: Data of 129 patients operated from March 2000 to January 2014 were retrieved retrospectively, and evaluated in terms of complications and post-operative pancreatic function. FU to July 2014. Results: Average 50.5 years (range 6-80), 57 M/72 F. Mean operation time was 274 minutes (range 98-490) and intraoperative blood loss 484.3 mL (range 50-2500). Median hospital stay: 13 days (range 7-63). Histology: 73 pancreatic tumors (33 serous cystadenoma, 26 neuroendocrine tumor, 8 IPMN, 4 solid-pseudopapillary tumor, 2 other tumor), 44 chronic pancreatitis, 5 other neoplasms, 7 other pancreatic pathology. Mean tumor size: 1.3 cm (range 0.2-8.0). Forty-three patients (33.3%) had a pancreatic fistula (POPF): 22 grade C, 20/22 treated by interventional radiology. Thirteen patients had a hemorrage (PPH), eight having a grade C POPF; 7/ 13 underwent re-operation and three died (mortality rate 2.3%). Median FU was 95months (range 6-172). Disease recurrence occurred in 3 patients (2.4%). Post-operatively, only 7 new onset mild diabetes, and 28 exocrine insufficiency (18 chronic pancreatitis) occurred. Conclusion: CP is an alternative option to distal pancreatectomy to treat benign and/or low-grade malignant lesions. CP has a high morbidity rate, but preserves endocrine and exocrine pancreatic function in longterm FU.

Laparoscopic central pancreatectomy for benign or low-grade malignant lesions in the pancreatic neck and proximal body

Laparoscopic central pancreatectomy (LCP) is a parenchyma-sparing minimally invasive surgical technique for removal of benign or low-grade malignant lesions from the neck and proximal body of the pancreas. The aim of this study was to compare the short- and long-term clinical outcomes of LCP with those of other pancreatectomies. During the study period, January 2007 to December 2010 (median follow-up 40.6months), 287 pancreatectomies were performed for lesions in the neck and proximal body of the pancreas. To compare the clinical outcomes of LCP and other pancreatectomies, 26 cases of LCP, 14 cases of open central pancreatectomy (OCP), and 96 cases of extended laparoscopic distal pancreatectomy (E-LDP) were selected. Tumor sizes in the LCP (2.2cm) and OCP (2.9cm) groups were smaller than in the E-LDP (4.0cm) group. Mean operation time in the LCP group (350.2min) was longer than in the OCP (270.3min) and E-LDP groups (210.6min). There were more surgical complications in the LCP (38.5%) and OCP groups (50%) than in the E-LDP group (14.6%). Mean duration of postoperative hospital stay was 13.8days for the LCP group, which was significantly shorter than for the OCP group (22.4days). New-onset diabetes was less frequent after LCP than after E-LDP (11.5 vs. 30.8%). In selected patients with small and benign tumors in the pancreatic neck and proximal body LCP leads to increased postoperative morbidity but earlier postoperative recovery than OCP, and excellent postoperative pancreatic function (compared with E-LDP). LCP should, therefore, be considered a valid therapeutic option for selected patients.

Nonalcoholic fatty liver disease after pancreatoduodenectomy is closely associated with postoperative pancreatic exocrine insufficiency.

In recent years, nonalcoholic fatty liver disease (NAFLD) after pancreatoduodenectomy (PD) has become increasingly problematic. Our aims were to clarify the relationship between NAFLD and postoperative pancreatic exocrine function and to identify the risk factors for NAFLD after PD. Patients who underwent PD (n = 104) were assessed with abdominal unenhanced computed tomography (CT) to determine the fatty liver changes and were given a (13) C-labeled mixed triglyceride breath test to measure pancreatic exocrine function. The percent (13) CO2 cumulative dose at 7 hr (% dose (13) C cum 7 hr) <5% was considered diagnostic for pancreatic exocrine insufficiency (PEI). Relationships between the occurrence of NAFLD and clinical factors including postoperative pancreatic exocrine function were analyzed. Twenty-six of 104 patients (25%) developed postoperative NAFLD. The postoperative CT attenuation of the liver (R = 0.326, P < 0.001) and the liver-to-spleen attenuation ratio (R = 0.315, P = 0.001) significantly correlated with the postoperative values of % dose (13) C cum 7 hr. Multivariate analysis determined that postoperative PEI was the only independent risk factor for NAFLD (P = 0.025). NAFLD frequently occurs postoperatively after PD. NAFLD after PD may be closely associated with postoperative PEI.

Patients get more long-term benefit from central pancreatectomy than distal resection: A meta-analysis

Central pancreatectomy (CP) protects more normal pancreatic parenchyma than distal pancreatectomy (DP), but the safety, feasibility and long-term benefit of CP are inconclusive. This meta-analysis aims to ascertain the relative merits of CP. A systematic literature research was performed to identify comparative studies on CP and DP. Perioperative and long-term outcomes constituted the end points. Pooled risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (95% CI) were calculated using either fixed effects or random effects model. Nine studies with 735 patients were included in this meta-analysis. Although CP cost more operative time than DP, the two groups had no significant differences in the volume of intraoperative blood loss, rate of intraoperative blood transfusion and length of postoperative hospital stay. According to the postoperative outcomes, although the CP group had higher overall complication rate (Fixed effects model; RR: 1.30; 95% CI: 1.05-1.62; P<0.05) as well as overall pancreatic fistula rate (Fixed effects model; RR: 1.58; 95% CI: 1.20-2.08; P<0.05), the two groups did not differ significantly in the fateful surgical complications such as clinically significant pancreatic fistula (Grades B and C), postoperative bleeding, reoperation and intra-abdominal effusion/abscess. Furthermore, the perioperative mortality rate was comparable between the two groups. During the follow-up period, the patients after DP were more likely to suffer pancreatic exocrine insufficiency (Fixed effects model; RR: 0.53; 95% CI: 0.32-0.86; P<0.05) and endocrine impairment (Fixed effects model; RR: 0.19; 95% CI: 0.11-0.33; P<0.05). CP was still an acceptable and feasible procedure, especially when considering the postoperative pancreatic function preservation ability by CP.

Preliminary result of enucleation for cystic lesion of pancreas preserving maximal pancreas function after operation

Background: The postoperative exocrine pancreatic function was compared between pancreatoduodenectomy and distal pancreatectomy, and we studied the relationship between the preoperative morphology of the pancreas expected to remain and pancreatic function after surgery.Patients and methods: In 27 patients who underwent pylorus-preserving pancreatoduodenectomy (PPPD group) and 12 who underwent distal pancreatectomy (DP group), the exocrine pancreatic function was assessed using the BT-PABA excretion test before surgery and short term after surgery (≤2 months). Preoperative morphology of the pancreas at a presumed line of transection was also investigated on computed tomography.Results: The mean urinary PABA excretion rate in the PPPD group decreased from 68.3% to 53.7% (P = 0.0029), whereas that in the DP group showed no significant change (70.7% versus 72.7%). The mean size of the main pancreatic duct at the presumed transection line in the PPPD group was significantly greater than that in the DP group (6.5 mm versus 2.6 mm, P = 0.0002). The mean parenchymal thickness of the pancreatic gland at the presumed transection line in the PPPD group was significantly smaller than that in the DP group (16.1 mm versus 18.6 mm, P = 0.04). The mean ratio of the pancreatic duct caliber to parenchymal thickness (duct-parenchymal ratio) in the PPPD group was significantly higher than that in the DP group (0.43 versus 0.14, P = 0.0004). There was a significant negative correlation between the postoperative PABA excretion rate and the duct-parenchymal ratio (P = 0.0057).Conclusions: The postoperative exocrine pancreatic function after PPPD and DP was significantly influenced by the morphology of the pancreas at the presumed transection line. It is important to evaluate the preoperative morphology of the presumably remaining pancreas, especially duct-parenchymal ratio, to predict the exocrine pancreatic function short term after pancreatectomy.

Pancreatic resections for cystic neoplasms: From the surgeon's presumption to the pathologist's reality

Pancreaticoduodenectomy (PD) is a complex procedure for management periampullary neoplasms The aim of our work is to report the surgical outcomes after PD in young adult (YA) (<35 years) and to compare it to a adult patients who underwent PD.We retrospectively analyzed the data of all patients who underwent PD in the period from January 1993 to December 2016. The primary outcome was the rate of total postoperative complications. Secondary outcomes included postoperative pathology, exocrine and endocrine function and survival rate.58/975 patients (5.9%) were YA and the majority of them were females. The incidence of post-operative complications in the YA was comparable to that in the adult group. Delayed gastric emptying developed significantly in adult group than YA group (0.008). The overall survival was significantly higher in the YA (P = 0.0001). The most common pathology in the YA was adenocarcinoma (41.4%) and solid pseudopapillary tumor (SPT) (29.3%). No significant difference as regards postoperative pancreatic exocrine and endocrine function in both groups.PD in YA when performed in tertiary centers with good surgical experience is safe. The most common pathological diagnosis in the YA was adenocarcinoma followed by SPT.

Parenchyma-Sparing Resections for Pancreatic Neuroendocrine Tumors

BackgroundParenchyma-sparing pancreatectomy (PSP), including enucleation and central pancreatectomy, has been investigated as an alternative to standard resection for pancreatic endocrine neoplasm, but the benefit/risk of these procedures remains little known. MethodsFrom 1998 to 2010, among 197 patients operated for well-differentiated pancreatic neuroendocrine tumors, 67 underwent PSP (45 enucleations and 22 central pancreatectomies) and 66 standard resections (35 pancreaticoduodenectomies and 31 distal pancreatectomies) for a tumor below 4 cm, without synchronous distant metastasis. Groups were compared regarding postoperative morbidity, mortality, long-term pancreatic function, and survival calculated using the Kaplan–Meier method. ResultsTumors operated by PSP had a median size of 15 mm, were mainly incidentally diagnosed (n = 46, 69 %), and nonfunctioning (n = 55, 82 %). Overall morbidity rate was higher after PSP than standard resection (SR) (76 vs 58 %, p = 0.0028), including more frequent pancreatic fistulas (69 vs 42 %, p = 0.003). Postoperative diabetes was less frequent following PSP than pancreaticoduodenectomy (5 vs 21 %; p = 0.022) but equivalent to the one observed after distal pancreatectomy (4 %, p = 1). Exocrine insufficiency was significantly less frequent after PSP than SR (3 vs 32 %; p < 0.0001). The overall and recurrence-free 5-year survival after PSP for nonfunctioning tumors was 96 and 98 %, respectively. ConclusionIn selected patients, with small and low-grade tumors, PSP are associated with excellent overall and recurrence-free survivals. These procedures are associated with an increased postoperative morbidity but an excellent postoperative pancreatic function. Therefore, they should be considered as a valid therapeutic option in selected well-differentiated pancreatic neuroendocrine tumors.

Histological Loss of Pancreatic Exocrine Cells Correlates With Pancreatic Exocrine Function After Pancreatic Surgery

The aim of this study was to investigate the relationship between histological findings of the pancreatic stump and postoperative pancreatic exocrine function. One hundred ten patients including 80 patients undergoing pancreatoduodenectomy (PD) and 30 patients undergoing distal pancreatectomy (DP) were enrolled into this study. Postoperative exocrine pancreatic function was evaluated by 13C-labeled mixed triglyceride breath test. The areas of acinar cells, fibrotic tissues, and fatty replacement were histologically calculated in surgical specimens of the pancreatic stump. Histologically, acinar cell area of patients undergoing PD was significantly less than that of patients undergoing DP (P = 0.025). The values of the mean percentage dose 13C cumulative 7 hours of patients undergoing PD were significantly lower than those of patients undergoing DP (P < 0.001). The rate of pancreatic exocrine insufficiency in patients undergoing PD is significantly higher than that in patients with DP (P = 0.002). There was a significant correlation between acinar cell area of the pancreatic stump and the percentage dose 13C cumulative 7 hours (R = 0.35, P < 0.001). Pancreatoduodenectomy induced pancreatic exocrine insufficiency more frequently than DP. Histological loss of acinar cells in the pancreatic stump was strongly correlated with postoperative pancreatic exocrine function.

Impact of techniques for gastrointestinal tract reconstruction following gastrectomy on pancreatic β-cell function in patients with type 2 diabetes mellitus

To evaluate the impact of different techniques for gastrointestinal tract reconstruction on postoperative pancreatic β-cell function in patients with type 2 diabetes mellitus (T2DM). Twenty-three patients with gastric cancer and T2DM were studied. Techniques for reconstruction included Billroth I (n=13) and bypass procedures(Billroth II n=4 and Roux-en-Y anastomosis n=6). Pancreatic β-cell function was evaluated by oral glucose tolerance test (OGTT). Serum insulin was measured by electrochemiluminescence immunoassay and blood glucose by glucose oxidase method. HOMA-IR and HOMA-β were assessed. T2DM remission rate was 90% (9/10) in the bypass group, and 23% (3/13) in Billroth I group (P<0.01). Glycosylated hemoglobin A1c and glycated hemoglobin HbA1 were improved significantly in patients after bypass procedures(P<0.05), but the difference in Billroth I group was not statistically significant (P>0.05). OGTT showed that fasting and post-glucose load plasma glucose at each time point were significantly lower in the bypass group compared to the Billroth I group. At 30 minutes and 60 minutes after glucose load, insulin levels and insulin release index were significantly higher in the bypass group compared to Billroth I( group, as were levels of HOMA-β and ΔI30/ΔG30 in the bypass group(P<0.05). Gastrointestinal bypass following gastrectomy may induce resolution of T2DM and improve β-cells function.

Surgical Pancreatic Ductal Drainage for Chronic Pancreatitis

To assess the efficacy of surgical pancreatic ductal drainage for chronic pancreatitis, we analyzed short-term and long-term outcomes and postoperative pancreatic function. Thirty-two surgical pancreatic ductal drainages (17 Frey procedures, 15 Partington procedures) were performed for patients with pain or relapsing acute pancreatitis due to obstruction of the main pancreatic duct including pancreatolithiasis. The short-term outcomes (mortality 0%, morbidity 34%) and pain relief (89%) after surgery were acceptable. In long-term follow-up periods after surgery, two patients (6%) had relapsing acute pancreatitis and one of them required further surgical pancreatic ductal drainage. Two patients were dead of liver failure but there was no development of pancreatic carcinoma. Fifty percent of the patients developed pancreatic exocrine insufficiency. Ninety percent of the patients who had normal preoperative endocrine function did not develop diabetes mellitus. Surgical pancreatic ductal drainage was safe and excellent in pain relief and preventing acute pancreatitis. Therefore, surgical procedures should be evaluated for patients with chronic pancreatitis who are intractable by endoscopic interventions before deterioration of the pancreatic function.