Metabolic Consequences of (Regional) Total Pancreatectomy

Abstract

Little information has been reported on the metabolic characteristics of the totally pancreatectomized patient or the efficacy of medical management after radical pancreatic surgery. The prospective evaluation of 49 such patients, with 31% followed for 48 or more months, forms the basis of this report. The major immediate postoperative challenge is control of diarrhea and weight stabilization. Chronically patients have an increased daily caloric requirement (mean +/- SE, 56 +/- 1 kcal/kg), not wholly explained by moderate steatorrhea (fecal fat excretion, 16% +/- 2% of unrestricted fat intake). Despite persistent malabsorption, deficiencies in fat-soluble vitamin, magnesium, and trace element serum levels can be prevented in most patients. Pancreatogenic diabetes is characterized by (1) absence of the major glucoregulatory hormones insulin and glucagon, (2) instability, and (3) frequent hypoglycemia, with the latter parameters improving with rigorous home glucose monitoring. No patient has developed clinically overt diabetic micro- or macrovascular disease. Performance status in long-term survivors has been reasonable. However adverse chronic sequelae of the operation occur and include an unusual frequency of liver disease, characterized by accelerated fatty infiltration, and osteopenia, with an 18% reduction in radial bone mineral content noted in pancreatectomized patients studied more than 5 years after surgery.

Improving Survival of Pancreatic Cancer. What Have We Learnt?

“…pancreatic fistula. However, total pancreatectomy comes with its own set of complications in the form of permanent exocrine insufficiency and poorly controlled diabetes [52,53].…”

Extent of surgical resections for intraductal papillary mucinous neoplasms

“…In the past, TP led to obligate diabetes mellitus with frequent hypoglycaemic episodes [25][26][27] as well as the development of severe malabsorption due to exocrine insufficiency [25][26][27][28][29] . Moreover the procedure was associated with significant mortality and morbidity.…”

Risk factors for development of nonalcoholic fatty liver disease after pancreatoduodenectomy

“…Therefore, long‐term metabolic complications have drawn considerable attention, and clinical studies have reported that hepatic steatosis occasionally occurs in patients who undergo PD 2, 3, 4, 5, 6, 7. This steatosis received little interest before the last decade because the patients did not usually have severe hepatic dysfunction clinically even though a few reports documented some cases of hepatic failure after pancreatic resection 8, 9, 10. The prevalence of this steatosis was reported to range from 7.8% to 37%,2, 3, 4, 5, 6, 11, 12 but a few reports are available on the time of occurrence and sequential change in the properties of this complication 13.…”