Comparison of the functional and morphological changes in the pancreatic remnant between pylorus-preserving pancreatoduodenectomy and pancreatoduodenectomy.
OBJECTIVE
Pylorus-preserving pancreatoduodenectomy preserves the secretion of gastrointestinal hormones from the distal stomach and duodenum, whereas after pancreatoduodenectomy they are no longer secreted. It has been suggested that some gastrointestinal hormones exert a trophic effect on the pancreas, although this effect has not been documented in man. It was postulated that the ablation of gastrointestinal hormones, such as gastrin by pancreatoduodenectomy is an important cause of postoperative pancreatic atrophy and, since pylorus-preserving pancreatoduodenectomy preserves the secretion of these hormones, it would be more effective than pancreatoduodenectomy for the maintenance of postoperative pancreatic function.


METHODS
We measured postoperative pancreatic function, parenchymal thickness of pancreas and the release of gastrin in patients who underwent pancreatoduodenectomy or pylorus-preserving pancreatoduodenectomy who had survived > 1 year without tumor recurrence.


RESULTS
After pylorus-preserving pancreatoduodenectomy, exocrine pancreatic function, parenchymal thickness of pancreas and gastrin release were significantly greater than after pancreatoduodenectomy.


CONCLUSIONS
We concluded that postoperative atrophy of the distal pancreas after pancreatoduodenectomy occurs, in part because of resections of the duodenum and distal stomach, which is the source of trophic stimuli, gastrin.
Hashimoto
Naoki
N
Second Department of Surgery, Kinki University School of Medicine, 377-2, Ohno-Higashi, Osaka Sayama, Osaka 589-8511, Japan. Hashiline@aol.com
Yasuda
Tikao
T
Haji
Seiji
S
Nomura
Hideaki
H
Ohyanagi
Harumasa
H
D014670:Ampulla of Vater / Q000601:surgery*; D001284:Atrophy; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D005500:Follow-Up Studies; D005755:Gastrins / Q000097:blood; D006801:Humans; D015596:Nutrition Assessment; D010043:Outcome and Process Assessment, Health Care; D010179:Pancreas / Q000473:pathology*; D010186:Pancreatic Function Tests; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000473:pathology*; D011706:Pyloric Antrum / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed
D005755:Gastrins