Clinical Outcomes after Total Pancreatectomy
- VernacularTitle:Нойр булчирхайг бүтнээр тайрах мэс заслын дараах эмнэлзүйн үр дүн
- Author:
Shuji Suzuki
- Publication Type:journal article
- From:Innovation
2014;8(4):128-129
- CountryMongolia
- Language:English
-
Abstract:
Background: Total pancreatectomy (TP) for pancreatic neoplasms has not been
shown to confer any benefit over less aggressive resections, and is associated
with high morbidity and mortality rates. Recently, clinical indications for TP are
increasingly reported, with advances in surgical techniques, improvements in
glycemic monitoring, and the development of synthetic insulin and pancreatic
enzymes. TP is indicated for patients with large invasive tumors, multifocal
intraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, and
longstanding chronic pancreatitis. Clinicophysiological findings after TP have
only been reported in a small number of cases, however. The aim of this study
was to evaluate clinicophysiological outcomes after TP.
Methods: A total of 41 patients who underwent TP between 2007 and 2013
at Tokyo Women’s Medical University were examined retrospectively.
Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, total
cholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liver
in CT) were collected and analyzed from preoperative state to 12 month after TP
(preoperative condition,1 month, 3 months, 6 months, and 12 months after TP).
Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured
12 months after TP. Average values were compared with Student’s t-test, and
numeric data are expressed as mean ± SD.
Results: There were 23 male and 18 female patients. The mean age was 65.2
years (range, 47–77 years). There were 25 patients with intraductal papillary
mucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 with
invasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillary
neoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma.
Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwent
subtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preserving
TP (DPTP). Preoperative measurements were as follows: BMI, 21.02 ± 0.46 kg/m2;
HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT,
63.05 ± 0.90 HU. No statistically significant differences in clinicophysiological
parameters were observed, except in HbA1c, which was significantly different
between the preoperative state and 12 months after TP. Albumin, creatinine,
lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, but
had normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin,
24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes
(lipase) was 18000 U, 12 month after TP.
Conclusions: Several clinicophysiological parameters, with the exception of
HbA1c, were temporarily decreased after TP, but had normalized by 12 months.
Therefore, treatment of pancreatic neoplasms with the potential to spread across
the entire pancreas by TP is feasible, and should be supplemented with adequate
administration of synthetic insulin and pancreatic enzyme supplements.
