Changes in Glucose Metabolism After Kausch-Whipple Pancreatectomy in Pancreatic Cancer and Chronic Pancreatitis Patients

Litwin, Jarosław; Dobrowolski, Sebastian; Orłowska-Kunikowska, Elżbieta; Śledziński, Zbigniew

doi:10.1097/mpa.0b013e318137aa61

Cited by 38 publications

(34 citation statements)

References 15 publications

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“…Significant improvements in glucose tolerance following partial pancreatectomy have previously been reported in patients with pancreatic cancer [15,36]. This finding has been attributed to an improvement in insulin sensitivity after removal of the pancreatic tumour [36].…”

Section: Discussionmentioning

confidence: 87%

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Metabolic consequences of a 50% partial pancreatectomy in humans

et al. 2008

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Aims/hypothesis Partial pancreatectomy is frequently performed in patients with pancreatic tumours or chronic pancreatitis, but little is known about the metabolic impact of this intervention. We examined the effects of approximately 50% partial pancreatectomy on glucose homeostasis and insulin secretion. Methods Fourteen patients with chronic pancreatitis, ten patients with pancreatic carcinoma and 13 patients with benign pancreatic tumours or extra-pancreatic masses (control group) underwent 240 min oral glucose tolerance tests before and after pancreatic tail-resection (n=12), duodenopancreatectomy (n=19) or duodenum-preserving pancreatic-head resection (n=6). Results Partial pancreatectomy led to a reduction in postchallenge insulin excursions by 49% in chronic pancreatitis patients, 52% in carcinoma patients and 55% in controls (p<0.05). Nevertheless, post-challenge glucose concentrations were transiently ameliorated after surgery (p<0.001). In the control participants, pancreatic-head resection caused a transient reduction of post-challenge glycaemia, whereas pancreatic-tail resection increased both fasting and postchallenge glycaemia (p<0.05). Insulin sensitivity was highest in chronic pancreatitis patients before surgery (p<0.01), but remained unchanged by the partial pancreatectomy. High pre-operative body weight and elevated fasting glucose levels were associated with poor glycaemic control after surgery. Conclusions/interpretation Insulin secretion is diminished after pancreatic-head and -tail resection, but post-challenge glucose concentrations can be ameliorated after pancreatichead resection. These data highlight the unequal impact of different surgical procedures on glucose control and suggest that obesity and high pre-operative glucose levels should be considered as risk factors for the development of hyperglycaemia after pancreatic surgery.

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Section: Discussionmentioning

confidence: 87%

“…Indeed, previous studies have alluded to significant impairments in insulin secretion and modest deteriorations in fasting glucose levels in patients undergoing partial pancreatectomy [10,[15][16][17]. However, the impact of a 50% partial pancreatectomy on post-challenge glucose excursions has been less well studied.…”

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confidence: 99%

Metabolic consequences of a 50% partial pancreatectomy in humans

et al. 2008

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“…Indeed, the quality of life has been shown to improve significantly after partial pancreatectomy in patients with persistent abdominal pain due to CP [21]. However, as beta cell mass is also reduced substantially by a partial pancreatectomy, any such intervention bears the potential risk of promoting the development of diabetes [22,23]. Therefore, it is important to identify clinical predictors of postoperative hyperglycaemia in order to allow for a better risk-benefit assessment before subjecting such patients to pancreatic surgery.…”

Section: Introductionmentioning

confidence: 99%

Determinants of glucose control in patients with chronic pancreatitis

et al. 2010

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Aims/hypothesis Diabetes frequently develops in patients with chronic pancreatitis (CP). Partial pancreatectomy has emerged as a treatment option for such patients. We addressed whether the development of diabetes in CP patients is related to pancreatic beta cell area or clinical variables, and which factors predict the diabetes risk after partial pancreatectomy. Methods Fractional beta cell area was determined in pancreatic tissue samples obtained from 114 CP patients undergoing pancreatic surgery and related to measures of glucose control, as well as clinical and anthropometric data. Seventy-four patients without diabetes at the time of surgery were contacted again 2.5±1.0 years after partial pancreatectomy in order to obtain information about the post-operative development of diabetes. Results In the surgical samples in the whole cohort, pancreatic beta cell area was 0.40±0.06% in patients with and 0.64±0.06% in those without previously known diabetes (p=0.039). There was an inverse non-linear relationship between pancreatic beta cell area and fasting glucose concentrations (r=0.29) as well as HbA 1c levels (r=0.36). Nineteen out of 74 previously normoglycaemic patients (26%) developed diabetes over an average period of 2.5 years of follow-up. Pre-operative fasting glucose levels, HbA 1c and BMI were identified as predictors of diabetes after partial pancreatectomy. However, pancreatic beta cell area did not differ in those who subsequently developed diabetes (0.66±0.15%) and those who did not (0.62± 0.08%, p=0.45). Conclusions/interpretation Hyperglycaemia in CP patients is associated with reduced beta cell area. However, reduced beta cell area does not predict the development of diabetes, suggesting that other factors are more important determinants of alterations in glucose metabolism in patients with CP.

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“…Compared with chronic pancreatitis, fewer patients (18–27%) with presumably normal pancreatic parenchyma develop diabetes mellitus after pancreatic resection for benign pancreatic tumors [32,33]. Amelioration of the diabetic state has been often observed after pancreatoduodenectomy for pancreatic cancer [34,35,36,37]. Mechanisms speculated to underlie the improved glucose metabolism following surgery include the removal of factors secreted by the adenocarcinoma and/or inflammation due to obstructive lesions of the pancreas and delayed gastric emptying.…”

Section: Incidence Of Diabetes After Pancreatic Resection (Table 1)mentioning

confidence: 99%