Risk factors of exocrine and endocrine pancreatic insufficiency after pancreatic resection: A multi-center prospective study.
Management of functional consequences after pancreatic resection has become a new therapeutic challenge. The goal of our study is to evaluate the risk factors for exocrine (ExoPI) and endocrine (EndoPI) pancreatic insufficiency after pancreatic surgery and to establish a predictive model for their onset.


PATIENTS AND METHODS
Between January 1, 2014 and June 19, 2015, 91 consecutive patients undergoing pancreatoduodenectomy (PD) or left pancreatectomy (LP) (72% and 28%, respectively) were followed prospectively. ExoPI was defined as fecal elastase content<200μg per gram of feces while EndoPI was defined as fasting glucose>126mg/dL or aggravation of preexisting diabetes. The volume of residual pancreas was measured according to the same principles as liver volumetry.


RESULTS
The ExoPI and EndoPI rates at 6 months were 75.9% and 30.8%, respectively. The rate of ExoPI after PD was statistically significantly higher than after LP (98% vs. 21%; P<0.001), while the rate of EndoPI was lower after PD vs. LP, but this difference did not reach statistical significance (28% vs. 38.5%; P=0.412). There was no statistically significant difference in ExoPI found between pancreatico-gastrostomy (PG) and pancreatico-jejunostomy (PJ) (100% vs. 98%; P=1.000). Remnant pancreatic volume less than 39.5% was predictive of ExoPI.


CONCLUSION
ExoPI occurs quasi-systematically after PD irrespective of the reconstruction scheme. The rate of EndoPI did not differ between PD and LP.
['Maignan|A|A|', 'Ouaïssi|M|M|', 'Turrini|O|O|', 'Regenet|N|N|', 'Loundou|A|A|', 'Louis|G|G|', 'Moutardier|V|V|', 'Dahan|L|L|', 'Pirrò|N|N|', 'Sastre|B|B|', 'Delpero|J-R|JR|', 'Sielezneff|I|I|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D004700:Endocrine System Diseases D010188:Exocrine Pancreatic Insufficiency D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008875:Middle Aged D010180:Pancreatectomy D016577:Pancreaticoduodenectomy D011183:Postoperative Complications D011446:Prospective Studies D012307:Risk Factors D055815:Young Adult
Pancreatic resection Endocrine pancreatic function Exocrine pancreatic function