Clinical Outcomes after Total Pancreatectomy / Шинэ санаа Шинэ нээлт

ABSTRACT

Background: Total pancreatectomy (TP) for pancreatic neoplasms has not been shown to confer any benefit over less aggressive resections, and is associated with high morbidity and mortality rates. Recently, clinical indications for TP are increasingly reported, with advances in surgical techniques, improvements in glycemic monitoring, and the development of synthetic insulin and pancreatic enzymes. TP is indicated for patients with large invasive tumors, multifocal intraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, and longstanding chronic pancreatitis. Clinicophysiological findings after TP have only been reported in a small number of cases, however. The aim of this study was to evaluate clinicophysiological outcomes after TP. Methods: A total of 41 patients who underwent TP between 2007 and 2013 at Tokyo Women’s Medical University were examined retrospectively. Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, total cholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liver in CT) were collected and analyzed from preoperative state to 12 month after TP (preoperative condition,1 month, 3 months, 6 months, and 12 months after TP). Basal, bolus, and total insulin as well as pancreatic enzymes, were also measured 12 months after TP. Average values were compared with Student’s t-test, and numeric data are expressed as mean ± SD. Results: There were 23 male and 18 female patients. The mean age was 65.2 years (range, 47–77 years). There were 25 patients with intraductal papillary mucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 with invasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillary neoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma. Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwent subtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preserving TP (DPTP). Preoperative measurements were as follows BMI, 21.02 ± 0.46 kg/m2; HbA1c, 6.42 ± 0.21% (29.3% of patients used insulin) and liver attenuation on CT, 63.05 ± 0.90 HU. No statistically significant differences in clinicophysiological parameters were observed, except in HbA1c, which was significantly different between the preoperative state and 12 months after TP. Albumin, creatinine, lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, but had normalized by 12 months. Basal insulin was 5.84 ± 0.55 U; bolus insulin, 24.79 ± 1.15 U; total insulin, 30.44 ± 1.48 U; and volume of pancreatic enzymes (lipase) was 18000 U, 12 month after TP. Conclusions: Several clinicophysiological parameters, with the exception of HbA1c, were temporarily decreased after TP, but had normalized by 12 months. Therefore, treatment of pancreatic neoplasms with the potential to spread across the entire pancreas by TP is feasible, and should be supplemented with adequate administration of synthetic insulin and pancreatic enzyme supplements.