Predictive factors of endocrine and exocrine insufficiency after resection of a benign tumour of the pancreas.
BACKGROUND
The aim of the present study is to evaluate the risk factors of endocrine and exocrine insufficiency occurring few years after pancreatic resections in a consecutive series of patients who underwent pancreatoduodenectomy (PD), left pancreatectomy (LP) or enucleation for benign neoplasms at a referral centre.


METHODS
Pancreatic exocrine insufficiency (PEI) was defined by the onset of steatorrhea associated with weight loss, and endocrine insufficiency was determinate by fasting plasma glucose. Association between pancreatic insufficiency and clinical, pathological, and perioperative features was studied using univariate and multivariate Cox regression analysis.


RESULTS
A prospective cohort of 92 patients underwent PD (48%), LP (44%) or enucleation (8%) for benign tumours, from 2005 to 2016 in the University Hospital in Poitiers (France). The median follow-up was 68.6±42.4months. During the following, 54 patients developed exocrine insufficiency whereas 32 patients presented endocrine insufficiency. In the Cox model, a BMI>28kg/m2, being a man and presenting a metabolic syndrome were significantly associated with a higher risk to develop postoperative diabetes. The risks factors for the occurrence of PEI were preoperative chronic pancreatitis, a BMI<18.5kg/m2, tumours located in the pancreatic head, biological markers of chronic obstruction and fibrotic pancreas. Undergoing LP or enucleation were protective factors of PEI. Histological categories such as neuroendocrine tumours and cystadenomas were also associated with a decreased incidence of PEI.


CONCLUSION
Men with metabolic syndrome and obesity should be closely followed-up for diabetes, and patients with obstructive tumours, pancreatic fibrosis or chronic pancreatitis require a vigilant follow up on their pancreatic exocrine function.
['Neophytou|Hélène|H|', 'Wangermez|Marc|M|', 'Gand|Elise|E|', 'Carretier|Michel|M|', 'Danion|Jérôme|J|', 'Richer|Jean-Pierre|JP|']
D000328:Adult D000368:Aged D001786:Blood Glucose D015331:Cohort Studies D003920:Diabetes Mellitus D010188:Exocrine Pancreatic Insufficiency D005260:Female D006801:Humans D007515:Islets of Langerhans D008297:Male D024821:Metabolic Syndrome D008875:Middle Aged D010180:Pancreatectomy D010190:Pancreatic Neoplasms D016577:Pancreaticoduodenectomy D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D045602:Steatorrhea
Endocrine Exocrine Insufficiency Benign Pancreas Bénin Chirurgie Insuffisance Pancréas Surgery