Long-Term Functional Outcome After Pancreatoduodenectomy for Periampullary Carcinoma With Morphological Correlation

Abstract

Objective The aim of the study was to evaluate the long-term functional outcome (exocrine and endocrine) and morphological changes in remnant pancreas after pancreatoduodenectomy and its clinical impact. Methods Periampullary carcinoma patients with minimum follow-up of 2 years and without recurrence were included (N = 102). Exocrine insufficiency includes clinical steatorrhea and fecal elastase-1 (FE-1) levels; endocrine insufficiency, glucose levels and glycated hemoglobin; and morphological changes, main pancreatic duct (MPD) diameter and thickness of remnant pancreas. Results The mean (standard deviation) follow-up period was 59 (26) months. Of the 102 patients, 81 (80%) had severely deficient FE-1 (0–100 μg/g). The preoperative MPD was significantly more and thickness of remnant pancreas was significantly less in patients with severely deficient FE-1. Overall, 15.6% (16/102) developed steatorrhea and improved on enzyme replacement therapy. The presence of MPD stricture (P = 0.008) and weight loss (P = 0.001) were significantly associated with steatorrhea. New-onset diabetes was seen in 17% (15/90) patients, of whom 3 of 5 developed it after 4 years (range, 4–7 years). The blood glucose was controlled on oral hypoglycemics in 2 (10/15) of 3 patients. Conclusions The assessment by FE-1 indicates loss of exocrine function in more than 90%, whereas only 1 of 6 developed steatorrhea and new-onset diabetes. Morphological changes especially MPD stricture affect the functional status of remnant pancreas.

Centralisation of Pancreatoduodenectomy in India: Where Do We Stand?

“…A total of 36 unique series [9–44] from 24 institutes across India were identified after excluding 18 series [45–62] due to overlap of cases from the same author and institution. Figure 1 depicts the consort chart of the study methodology.…”

The Expression of Immune Checkpoint Inhibitors PDL-1 and CTLA-4 in Pancreatic Versus Non-Pancreatic Periampullary Adenocarcinoma: An Immunohistochemical Study

“…They comprised tumors of diverse origins and generally subdivided into pancreatic (PC) and nonpancreatic carcinomas with the latter having a more favourable prognosis and better overall survival rates (Siegel et al, 2015;Sunil et al, 2017). Histologically, all periampullary cancers are predominantly adenocarcinomas and all are regarded as tumors with the worst prognosis worldwide, with spiky disease-related mortality (Saluja et al, 2019).…”

Nutritional status of patients undergoing pancreatic resection

“…Лабораторные исследования относительно ЭНПЖ не проводились [1]. В исследовании Saluja и соавт., среди 102 пациентов более чем у 80% через 2 года после ПДР по поводу ампулярного рака лабораторно диагностирована тяжелая ЭНПЖ, хотя клинически стеаторея прослеживалась лишь у 16 (15,6%) [24].…”