TY - JOUR
T1 - Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy
AU - Kusakabe, Jiro
AU - Anderson, Blaire
AU - Liu, Jingxia
AU - Williams, Gregory A.
AU - Chapman, William C.
AU - Doyle, Majella M.B.
AU - Khan, Adeel S.
AU - Sanford, Dominic E.
AU - Hammill, Chet W.
AU - Strasberg, Steven M.
AU - Hawkins, William G.
AU - Fields, Ryan C.
N1 - Publisher Copyright:
© 2019, The Society for Surgery of the Alimentary Tract.
PY - 2019/8/15
Y1 - 2019/8/15
N2 - Purpose: To identify peri-operative risk factors and time to onset of pancreatic endocrine/exocrine insufficiency. Methods: We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2000 and 2015. Endocrine/exocrine insufficiencies were defined as need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative pancreatic insufficiency. Results: A total of 1717 patient records were analyzed (75.47% PD, 24.53% DP) at median follow-up 17.88 months. Average age was 62.62 years, 51.78% were male, and surgery was for malignancy in 74.35% of patients. Post-operative endocrine insufficiency was present in 20.15% (n = 346). Male gender (p = 0.015), increased body mass index (BMI) (p < 0.001), tobacco use (p = 0.011), family history of diabetes (DM) (p < 0.001), personal history of DM (p ≤ 0.001), and DP (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 20.80 ± 33.60 (IQR: 0.49–28.37) months. Post-operative exocrine insufficiency was present in 36.23% (n = 622). Race (p = 0.014), lower BMI (p < 0.001), family history of DM (p = 0.007), steatorrhea (p < 0.001), elevated pre-operative bilirubin (p = 0.019), and PD (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 14.20 ± 26.90 (IQR: 0.89–12.69) months. Conclusions: In this large series of pancreatectomy patients, 20.15% and 36.23% of patients developed post-operative endocrine and exocrine insufficiency at a mean time to onset of 20.80 and 14.20 months, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness long-term.
AB - Purpose: To identify peri-operative risk factors and time to onset of pancreatic endocrine/exocrine insufficiency. Methods: We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2000 and 2015. Endocrine/exocrine insufficiencies were defined as need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative pancreatic insufficiency. Results: A total of 1717 patient records were analyzed (75.47% PD, 24.53% DP) at median follow-up 17.88 months. Average age was 62.62 years, 51.78% were male, and surgery was for malignancy in 74.35% of patients. Post-operative endocrine insufficiency was present in 20.15% (n = 346). Male gender (p = 0.015), increased body mass index (BMI) (p < 0.001), tobacco use (p = 0.011), family history of diabetes (DM) (p < 0.001), personal history of DM (p ≤ 0.001), and DP (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 20.80 ± 33.60 (IQR: 0.49–28.37) months. Post-operative exocrine insufficiency was present in 36.23% (n = 622). Race (p = 0.014), lower BMI (p < 0.001), family history of DM (p = 0.007), steatorrhea (p < 0.001), elevated pre-operative bilirubin (p = 0.019), and PD (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 14.20 ± 26.90 (IQR: 0.89–12.69) months. Conclusions: In this large series of pancreatectomy patients, 20.15% and 36.23% of patients developed post-operative endocrine and exocrine insufficiency at a mean time to onset of 20.80 and 14.20 months, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness long-term.
KW - Distal pancreatectomy
KW - Pancreatic endocrine insufficiency
KW - Pancreatic enzyme replacement
KW - Pancreatic exocrine insufficiency
KW - Pancreaticoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=85060636797&partnerID=8YFLogxK
U2 - 10.1007/s11605-018-04084-x
DO - 10.1007/s11605-018-04084-x
M3 - Article
C2 - 30671791
AN - SCOPUS:85060636797
SN - 1091-255X
VL - 23
SP - 1604
EP - 1613
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 8
ER -