Pancreatic insufficiency after different resections for benign tumours.
BACKGROUND
Pancreatic resections for benign diseases may lead to long-term endocrine/exocrine impairment. The aim of this study was to compare postoperative and long-term results after different pancreatic resections for benign disease.


METHODS
Between 1990 and 1999, 62 patients underwent pancreaticoduodenectomy (PD), 36 atypical resection (AR) and 64 left pancreatectomy (LP) for benign tumours. Exocrine and endocrine pancreatic function was evaluated by 72-h faecal chymotrypsin and oral glucose tolerance test.


RESULTS
The incidence of pancreatic fistula was significantly higher after AR than after LP (11 of 36 versus seven of 64; P = 0.028). The long-term incidence of endocrine pancreatic insufficiency was significantly lower after AR than after PD (P < 0.001). Exocrine insufficiency was more common after PD (P < 0.001) and LP (P = 0.009) than after AR. The probability of developing both endocrine and exocrine insufficiency was higher for PD and LP than for AR (32, 27 and 3 per cent respectively at 1 year; 58, 29 and 3 per cent at 5 years; P < 0.001).


CONCLUSIONS
Different pancreatic resections are associated with different risks of developing long-term pancreatic insufficiency. AR represents the best option in terms of long-term endocrine and exocrine function, although it is associated with more postoperative complications.
Department of Surgery, University of Verona, Verona, Italy. massimo.falconi@univr.it
M
M
Falconi
W
W
Mantovani
S
S
Crippa
G
G
Mascetta
R
R
Salvia
P
P
Pederzoli
D000368:Aged; D002918:Chymotrypsin / Q000032:analysis; D010188:Exocrine Pancreatic Insufficiency / Q000209:etiology* / Q000503:physiopathology; D005243:Feces / Q000737:chemistry; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000503:physiopathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012307:Risk Factors; D016896:Treatment Outcome
D002918:Chymotrypsin