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22.01.2019 | Original Article | Ausgabe 8/2019

Journal of Gastrointestinal Surgery 8/2019

Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 8/2019
Autoren:
Jiro Kusakabe, Blaire Anderson, Jingxia Liu, Gregory A. Williams, William C. Chapman, Majella M. B. Doyle, Adeel S. Khan, Dominic E. Sanford, Chet W. Hammill, Steven M. Strasberg, William G. Hawkins, Ryan C. Fields
Wichtige Hinweise
Jiro Kusakabe and Blaire Anderson contributed equally to this work.
Presented at the American Hepato-Pancreato-Biliary Association Annual Meeting, Miami Beach, FL, March-April 2018.

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Abstract

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.

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