Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy.
OBJECTIVE
Pancreatic exocrine insufficiency has been reported to be more common in pancreaticogastrostomy (PG) than in pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). This study aimed to evaluate the long-term outcome after PD between these 2 groups.


METHODS
We evaluated the long-term functional status of 42 surviving patients diagnosed with periampullary lesions who underwent PJ or PG after PD and followed up for more than 1 year. Among these, 23 patients underwent PJ and 19 patients underwent PG. To compare the 2 groups, we analyzed the (1) pancreatic exocrine insufficiency by questioning the presence or absence of steatorrhea, (2) pancreatic endocrine function by measuring glycohemoglobin A1c, fasting blood glucose, and history of new-onset diabetes, (3) nutritional status by measuring serum total protein, albumin, cholesterol, and triglyceride, (4) gastric emptying time, (5) panendoscopic findings, (6) changes of pancreatic duct diameter by computed tomography, and (7) relaparotomy rate.


RESULTS
The mean follow-up time for PG and PJ were 37 +/- 23 and 103 +/- 52 months, respectively (P < 0.05). A total of 52.4% patients developed pancreatic exocrine insufficiency, and 11.9% had new-onset diabetes. There was no significant difference between PJ and PG groups. A significantly improved postoperative nutritional state regarding serum total protein and albumin were noticed in both groups. There was no significant difference in terms of gastric emptying time, positive panendoscopic findings, and changes in pancreatic duct diameter. The pancreatic remnant-related relaparotomy rate was higher in the PJ group as compared with the PG group (17.4% vs 0%; P = 0.056).


CONCLUSIONS
There is no significant difference in pancreatic exocrine or endocrine insufficiency, gastric emptying time, and positive panendoscopic findings between PJ and PG. Pancreaticojejunostomy was associated with a higher pancreatic remnant-related relaparotomy rate; however, because of a shorter follow-up in the PG group, a continuous long-term follow-up is still needed.
Fang
Wen-Liang
WL
Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Su
Cheng-Hsi
CH
Shyr
Yi-Ming
YM
Chen
Tien-Hua
TH
Lee
Rheun-Chuan
RC
Tai
Ling-Chen
LC
Wu
Chew-Wun
CW
Lui
Wing-Yiu
WY
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001786:Blood Glucose / Q000378:metabolism; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D003920:Diabetes Mellitus / Q000209:etiology; D004379:Duodenal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007515:Islets of Langerhans / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D046790:Pancreas, Exocrine / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D045602:Steatorrhea / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human