Clinical Outcomes after Total Pancreatectomy / Шинэ санаа Шинэ нээлт

ABSTRACT

Background: Total pancreatectomy (TP) for pancreatic neoplasms has not beenshown to confer any benefit over less aggressive resections, and is associatedwith high morbidity and mortality rates. Recently, clinical indications for TP areincreasingly reported, with advances in surgical techniques, improvements inglycemic monitoring, and the development of synthetic insulin and pancreaticenzymes. TP is indicated for patients with large invasive tumors, multifocalintraductal papillary mucinous neoplasms, multifocal islet cell neoplasms, andlongstanding chronic pancreatitis. Clinicophysiological findings after TP haveonly been reported in a small number of cases, however. The aim of this studywas to evaluate clinicophysiological outcomes after TP.Methods: A total of 41 patients who underwent TP between 2007 and 2013at Tokyo Women’s Medical University were examined retrospectively.Clinicophysiological parameters (BMI, HbA1c, albumin, creatinine, totalcholesterol, triglycerides, WBC, lymphocytes, hemoglobin, HU level of the liverin 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 measured12 months after TP. Average values were compared with Student’s t-test, andnumeric data are expressed as mean ± SD.Results: There were 23 male and 18 female patients. The mean age was 65.2years (range, 47–77 years). There were 25 patients with intraductal papillarymucinous neoplasms (5 low grade, 8 high grade, and 12 invasive); 13 withinvasive pancreatic ductal carcinoma; 1 with intraductal tubulopapillaryneoplasm; and 2 with multiple pancreatic metastases from renal cell carcinoma.Twenty-eight patients underwent pylorus-preserving TP (PPTP); 8 underwentsubtotal stomach-preserving TP (SSPTP); and 5 underwent duodenum-preservingTP (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 clinicophysiologicalparameters were observed, except in HbA1c, which was significantly differentbetween the preoperative state and 12 months after TP. Albumin, creatinine,lymphocytes and hemoglobin were decreased at 1, 3, and 6 months after TP, buthad 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 ofHbA1c, were temporarily decreased after TP, but had normalized by 12 months.Therefore, treatment of pancreatic neoplasms with the potential to spread acrossthe entire pancreas by TP is feasible, and should be supplemented with adequateadministration of synthetic insulin and pancreatic enzyme supplements.