title: Metabolic consequences of a 50% partial pancreatectomy in humans.
abstract: OBJECTIVE
  Partial pancreatectomy is frequently performed in patients with pancreatic tumours or chronic pancreatitis, but little is known about the metabolic impact of this intervention. We examined the effects of approximately 50% partial pancreatectomy on glucose homeostasis and insulin secretion.
  
  
  METHODS
  Fourteen patients with chronic pancreatitis, ten patients with pancreatic carcinoma and 13 patients with benign pancreatic tumours or extra-pancreatic masses (control group) underwent 240 min oral glucose tolerance tests before and after pancreatic tail-resection (n = 12), duodenopancreatectomy (n = 19) or duodenum-preserving pancreatic-head resection (n = 6).
  
  
  RESULTS
  Partial pancreatectomy led to a reduction in post-challenge insulin excursions by 49% in chronic pancreatitis patients, 52% in carcinoma patients and 55% in controls (p < 0.05). Nevertheless, post-challenge glucose concentrations were transiently ameliorated after surgery (p < 0.001). In the control participants, pancreatic-head resection caused a transient reduction of post-challenge glycaemia, whereas pancreatic-tail resection increased both fasting and post-challenge glycaemia (p < 0.05). Insulin sensitivity was highest in chronic pancreatitis patients before surgery (p < 0.01), but remained unchanged by the partial pancreatectomy. High pre-operative body weight and elevated fasting glucose levels were associated with poor glycaemic control after surgery.
  
  
  CONCLUSIONS
  Insulin secretion is diminished after pancreatic-head and -tail resection, but post-challenge glucose concentrations can be ameliorated after pancreatic-head resection. These data highlight the unequal impact of different surgical procedures on glucose control and suggest that obesity and high pre-operative glucose levels should be considered as risk factors for the development of hyperglycaemia after pancreatic surgery.
authors.affiliation: Department of Medicine I, St Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany.
authors.forename: B A
authors.initials: BA
authors.lastname: Menge
authors.forename: H
authors.initials: H
authors.lastname: Schrader
authors.forename: T G K
authors.initials: TG
authors.lastname: Breuer
authors.forename: Y
authors.initials: Y
authors.lastname: Dabrowski
authors.forename: W
authors.initials: W
authors.lastname: Uhl
authors.forename: W E
authors.initials: WE
authors.lastname: Schmidt
authors.forename: J J
authors.initials: JJ
authors.lastname: Meier
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D002277:Carcinoma / Q000097:blood / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000601:surgery; D005260:Female; D005951:Glucose Tolerance Test; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D000078790:Insulin Secretion; D050417:Insulin-Secreting Cells / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000097:blood / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000097:blood / Q000601:surgery*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007328:Insulin