Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy

Struyvenberg, Maarten R.; Fong, Zhi Ven; Martin, Camilia R.; Tseng, Jennifer F.; Clancy, Thomas E.; Castillo, Carlos Fernández‐del; Tillman, Hanna; Bellin, Melena D.; Freedman, Steven D.

doi:10.1016/s0016-5085(17)33081-0

Cited by 5 publications

(7 citation statements)

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“…Moreover, recent studies have reported improved perioperative outcomes and postoperative QoL after TP, presumably due to centralization at high-volume centers and development of long-acting insulin and modern pancreatic enzyme preparations. [10][11][12][13][14] Postoperative pancreatic fistula (POPF) is the main cause of surgical morbidity after pancreatoduodenectomy (PD). Several risk score systems based on pre-and intraoperative parameters, such as the fistula risk score (FRS) or the alternative fistula risk score (a-FRS), have been proposed to predict the occurrence of POPF and stratify patients based on this risk.…”

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confidence: 99%

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Marchegiani

Perri²,

Burelli³

et al. 2021

Annals of Surgery

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Objective: To evaluate TP as an alternative to PD in patients at high-risk for popf. Background: Outcomes of high-risk PD (HR-PD) and TP have never been compared. Methods: All patients who underwent PD or TP between July 2017 and December 2019 were identified. HR-PD was defined according to the alternative fistula risk score. Postoperative outcomes (primary endpoint), pancreatic insufficiency, and quality of life after 12 months of follow-up (QoL) were compared between HR-PD or planned PD intraoperatively converted to TP (C-TP). Results: A total of 566 patients underwent PD and 136 underwent TP during the study period. One hundred one (18%) PD patients underwent HR-PD, whereas 86 (63%) TP patients underwent C-TP. Postoperatively, the patients in the C-TP group exhibited lower rates of postpancreatectomy hemorrhage (15% vs 28%), delayed gastric emptying (16% vs 34%), sepsis (10% vs 31%), and Clavien-Dindo ≥3 morbidity (19% vs 31%) and had shorter median lengths of hospital stay (10 vs 21 days) (all P < 0.05). The rate of POPF in the HR-PD group was 39%. Mortality was comparable between the 2 groups (3% vs 4%). Although general, cancer- and pancreas-specific QoL were comparable between the HR-PD and C-TP groups, endocrine and exocrine insufficiency occurred in all the C-TP patients, compared to only 13% and 63% of the HR-PD patients, respectively, and C-TP patients had worse diabetesspecific QoL. Conclusions: C-TP may be considered rather than HR-PD only in few selected cases and after adequate counseling.

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confidence: 99%

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Marchegiani

Perri²,

Burelli³

et al. 2021

Annals of Surgery

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“…[11][12][13] In many tumors, hyperglycemia and diabetes are associated with higher aggressiveness. In addition, DM is frequently present at diagnosis in advanced pNETs as a consequence of pancreatic involvement by the tumor; rarely, paraneoplastic syndromes (glucagonomas) 14 ; or, more often, surgical 15 (partial or total pancreatectomy) or medical (SSAs or everolimus) treatments. 5,8,[16][17][18] In particular, everolimus induces insulin resistance and hyperinsulinemia through the combination of impaired insulin secretion and insulin resistance, whereas SSAs inhibit insulin secretion because of an induced decrease in pancreatic b-cell function.…”

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confidence: 99%

Metformin Use Is Associated With Longer Progression-Free Survival of Patients With Diabetes and Pancreatic Neuroendocrine Tumors Receiving Everolimus and/or Somatostatin Analogues

et al. 2018

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“…Extended resection could lead to autonomic denervation and therefore impaired bowel control, explaining the difference in severity of diarrhoea between benign and malignant indications 2,6 . Nevertheless, the potential for sufficient stool management and improvement of nutritional status over time suggests a crucial role for extensive patient education and follow-up to optimize pancreatic enzyme replacement therapy 18,33,42 . Moreover, optimal nutritional status seems to be important to reduce the risk of hepatic steatosis 25,33 .…”

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confidence: 99%

Systematic review of functional outcome and quality of life after total pancreatectomy

Scholten¹,

Stoop²,

Chiaro

et al. 2019

British Journal of Surgery

101

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BackgroundSurgeons have traditionally been reluctant to perform total pancreatectomy because of concerns for brittle diabetes and poor quality of life (QoL). Several recent studies have suggested that outcomes following total pancreatectomy have improved, but a systematic review is lacking.MethodsA systematic review was undertaken of studies reporting on outcomes after total pancreatectomy for all indications, except chronic pancreatitis. PubMed, EMBASE (Ovid), and Cochrane Library were searched (2005–2018). Endpoints included functional outcome and QoL.ResultsA total of 21 studies, including 1536 patients, fulfilled the eligibility criteria. During a median follow‐up of 20·8 (range 1·5–96·0) months, 18·6 per cent (45 of 242 patients) were readmitted for endocrine‐related morbidity, with associated mortality in 1·6 per cent (6 of 365 patients). No diabetes‐related mortality was reported in studies including only patients treated after 2005. Symptoms related to exocrine insufficiency were reported by 43·5 per cent (143 of 329 patients) during a median follow‐up of 15·9 (1·5–96·0) months. Overall QoL, reported by 102 patients with a median follow‐up of 28·6 (6·0–66·0) months, using the EORTC QLQ‐C30 questionnaire, showed a moderately reduced summary score of 76 per cent, compared with a general population score of 86 per cent (P = 0·004).ConclusionOverall QoL after total pancreatectomy is affected adversely, in particular by the considerable impact of diarrhoea that requires better treatment. There is also room for improvement in the management of diabetes after total pancreatectomy, particularly with regards to prevention of diabetes‐related morbidity.

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Impact of Treatments on Diabetic Control and Gastrointestinal Symptoms after Total Pancreatectomy

Cited by 5 publications

References 0 publications

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

High-risk Pancreatic Anastomosis Versus Total Pancreatectomy After Pancreatoduodenectomy

Metformin Use Is Associated With Longer Progression-Free Survival of Patients With Diabetes and Pancreatic Neuroendocrine Tumors Receiving Everolimus and/or Somatostatin Analogues

Systematic review of functional outcome and quality of life after total pancreatectomy

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