Functional changes and morbidity after pancreatic surgery: a plea to increase awareness
20 april 2018
Antwerp University Hospital (UZA) - Auditorium Kinsbergen (route 12) - Wilrijkstraat 10 - 2650 EDEGEM
Organisatie / co-organisatie:
Faculty of Medicine and Health Sciences
Prof D. Ysebaert & Prof C. De Block
PhD defence Geert Roeyen - Faculty of Medicine and Health Sciences
Patients referred for pancreatic surgery, are concerned about their postoperative quality of life. They are aware that the pancreas mediates glycemic control, but are less aware of its exocrine function.
There are several reasons why physicians should pay more attention should be paid to functional changes after pancreatectomy. Nowadays, more patients are operated for premalignant lesions After resection, patients are considered ‘cured’ and have a long life expectancy. Another reason is that patients with malignant disease should be kept in the best possible physical condition to endure adjuvant chemotherapy.
In the recent medical literature, the type of diabetes in patients undergoing pancreatectomy or suffering from a pancreatic neoplasm, is reported to be different from type 1 and 2 diabetes. It is considered type 3c diabetes.
In 2013-2014, all patients referred for pancreatic surgery, were screened systematically for functional problems. According to the American Diabetes Association’s criteria, an important proportion had diabetes but did not know it. For the patient, the perception to have ‘diabetes as a consequence of the operation’ could shift towards ‘pre-existing diabetes which could improve or deteriorate after surgery’.
An update of this screening was analyzed for all patients referred for pancreatic surgery between 2013-2016. In the group patients operated for pancreatic adenocarcinoma, ‘unknown’ diabetes was as frequent as history of diabetes.
The evolution of pancreatic function after pancreaticoduodenectomy was evaluated. A subgroup could be identified in whom function improved after surgery: these were patients with preoperative ‘unknown’ diabetes. Several factors were identified correlating to different patterns of functional evolution.
In patients undergoing distal pancreatectomy, several volumetric parameters have been correlated to function. We tried to find a correlation for patients undergoing pancreaticoduodenectomy, but the outcome was the opposite of the expected: volumetric assessment correlated with exocrine, not with endocrine function.
During follow-up of patients undergoing pancreaticoduodenectomy with pancreaticogastrostomy reconstruction, many developed pancreatic exocrine insufficiency resulting in steatorrhea, weight loss and malnutrition. We compared the results of exocrine function between pancreaticogastrostomy and pancreaticojejunostomy reconstruction. Exocrine insufficiency was much more frequent after pancreaticogastrostomy.
A study suggesting that exocrine insufficiency could be predicted by preoperative reduced parenchymal thickness was reevaluated, because this study had been criticized before in medical literature: patients were not selected by baseline measurements. A relation between main pancreatic duct diameter and exocrine insufficiency could be found no longer.