Comparison of Postoperative Morphological Changes in Remnant Pancreas Between Pancreaticojejunostomy and Pancreaticogastrostomy After Pancreaticoduodenectomy

Tomimaru, Yoshito; Takeda, Yutaka; Kobayashi, Shogo; Marubashi, Shigeru; Lee, Chun Man; Tanemura, Masahiro; Nagano, Hiroaki; Kitagawa, Toru; Dono, Keizo; Umeshita, Koji; Wakasa, Kenichi; Monden, Morito

doi:10.1097/mpa.0b013e31818e1772

Cited by 47 publications

(61 citation statements)

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“…The preoperative morphology of the pancreas was examined by CT [17,18]. Abdominal CT scans were performed within one month prior to surgery.…”

Section: Methodsmentioning

confidence: 99%

“…The thickness was also measured manually in the region of the pancreas where the maximum MPD diameter was determined at the pancreatic tail side of the neoplasm (Fig. 1) [17].…”

Section: Methodsmentioning

confidence: 99%

“…However, three-dimensional analysis of the pancreas is not common in current clinical practice. In the present study, we analyzed the relationships between various preoperative parameters, including pancreatic thickness (easily measured by CT with two-dimensional imaging [17,18] as a parameter reflecting the total postoperative remnant pancreatic volume, and postoperative insulin secretion to determine which parameter would best predict postoperative insulin secretion. We also analyzed the optimal preoperative cut-off values for identifying subjects requiring postoperative insulin therapy.…”

Section: Methodsmentioning

confidence: 99%

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Preoperative insulin secretion ability and pancreatic parenchymal thickness as useful parameters for predicting postoperative insulin secretion in patients undergoing pancreaticoduodenectomy

et al. 2012

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PeriamPullary malignant neoplasms have been increasing in Japan, mainly in response to an increase in the incidences of pancreatic cancer. The surgical resection rate has also been increasing because of recent advances in surgical techniques. Pancreatic cancer is the fifth leading cause of cancer-related death in Preoperative insulin secretion ability and pancreatic parenchymal thickness as useful parameters for predicting postoperative insulin secretion in patients undergoing pancreaticoduodenectomy abstract. Periampullary malignant neoplasms have been increasing in Japan, mainly in response to an increase in the incidences of pancreatic cancer, and glucose intolerance due to deterioration of insulin secretion is an important problem. We investigated preoperative parameters to predict postoperative insulin secretion and the need for insulin therapy in patients undergoing pancreaticoduodenectomy (PD). Thirty-six patients with malignant neoplasms of periampullary lesions were enrolled. Preoperative pancreatic parenchymal thickness was evaluated by computed tomography. Insulin secretion and glucose tolerance were evaluated by a 75-g oral glucose tolerance test and an intravenous glucagon loading test. The relationships between postoperative insulin secretion and preoperative parameters and the cut-off values for predicting the need for postoperative insulin therapy for glycemic control were investigated. Pancreatic parenchymal thickness and other preoperative parameters, including the increment of serum C-peptide (∆ C-peptide), fasting plasma C-peptide (F-CPR), insulinogenic index (I.I.) and fasting plasma glucose (FPG), were significantly associated with postoperative insulin secretion. Multiple regression analyses revealed that preoperative ∆ C-peptide or F-CPR was the most significant determinant of postoperative insulin secretion, followed by pancreatic parenchymal thickness. In the receiver operating characteristic curve, the best preoperative cut-off values for predicting the need for postoperative insulin therapy were a ∆ C-peptide of 0.65 ng/mL, a F-CPR of 0.85 ng/mL and a pancreatic parenchymal thickness of 6.0 mm. Both preoperative insulin secretion and pancreatic parenchymal thickness effectively predict postoperative insulin secretion and identify subjects who need postoperative insulin therapy for glycemic control.Key words: Pancreaticoduodenectomy, Insulin secretion, Glucose tolerance, Pancreatic parenchymal thickness males and the sixth leading cause in females in Japan [1], and pancreaticoduodenectomy (PD) is the main operative procedure, accounting for approximately 60% of all pancreatic cancer surgery [2]. Among the complications of PD, glucose intolerance is an important problem, and diabetes mellitus develops postoperatively in 20-50% of patients [3,4]. PD involves the surgical reduction of approximately 50% of the pancreatic parenchymal tissue [5], and insulin secretion usually deteriorates because of a reduction in beta cell mass [5][6][7][8]. Glucose tolerance is determined by the balance be...

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“…The preoperative morphology of the pancreas was examined by CT [17,18]. Abdominal CT scans were performed within one month prior to surgery.…”

Section: Methodsmentioning

confidence: 99%

“…The thickness was also measured manually in the region of the pancreas where the maximum MPD diameter was determined at the pancreatic tail side of the neoplasm (Fig. 1) [17].…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Preoperative insulin secretion ability and pancreatic parenchymal thickness as useful parameters for predicting postoperative insulin secretion in patients undergoing pancreaticoduodenectomy

et al. 2012

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“…The late outcome of PD is monitored by oncological results and quality of life. The objective of pancreatic remnant condition is established on the basis of pancreatic function preservation and imaging criteria [16,24,27]. Several investigators supposed to find the correlation between the technique of pancreatic remnant anastomosis and its function [9,16,27].…”

Section: Introductionmentioning

confidence: 99%

“…The objective of pancreatic remnant condition is established on the basis of pancreatic function preservation and imaging criteria [16,24,27]. Several investigators supposed to find the correlation between the technique of pancreatic remnant anastomosis and its function [9,16,27]. The reduction of glandular tissue, pancreatic remnant duct patency, deficiency of duodenal stimulation to pancreas and inactivation of pancreatic enzymes are considered important factors of maldigestion related to pancreatic function [24].…”

Section: Introductionmentioning

confidence: 99%

Pancreatic remnant fate

et al. 2015

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Longitudinal Pancreaticojejunostomy for Pancreaticodigestive Tract Anastomotic Stricture After Pancreaticoduodenectomy

Matsumoto

Kamei

Kawaguchi

et al. 2021

Annals of Gastroent Surgery

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Comparison of Postoperative Morphological Changes in Remnant Pancreas Between Pancreaticojejunostomy and Pancreaticogastrostomy After Pancreaticoduodenectomy

Abstract: Considering the above postoperative morphological changes, PJ seems to be preferable to PG after pancreaticoduodenectomy.

Cited by 47 publications

References 12 publications

Preoperative insulin secretion ability and pancreatic parenchymal thickness as useful parameters for predicting postoperative insulin secretion in patients undergoing pancreaticoduodenectomy

Preoperative insulin secretion ability and pancreatic parenchymal thickness as useful parameters for predicting postoperative insulin secretion in patients undergoing pancreaticoduodenectomy

Pancreatic remnant fate

Longitudinal Pancreaticojejunostomy for Pancreaticodigestive Tract Anastomotic Stricture After Pancreaticoduodenectomy

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