Metabolic and target organ outcomes after total pancreatectomy: Mayo Clinic experience and meta-analysis of the literature.
BACKGROUND
Total pancreatectomy (TP) has been associated with substantial metabolic abnormalities and poor glycaemic control limiting its use. Because data reported to date are limited, we evaluated outcomes related to the diabetes mellitus obligated by TP.


METHODS
A case series study of all patients who underwent TP from 01/01/1985 to 12/31/2006 at Mayo Clinic was conducted. TP cases were summarized according to perioperative procedures, mortality and morbidity after TP. To complement this retrospective examination, a survey was developed to measure DM treatment modality, target organ failure and complications in patients alive in 2007. We performed a meta-analysis to compare our results with similar previous studies and provide overall estimates of outcomes.


RESULTS
A total of 141 cases were studied (97 malignant diseases, 44 benign diseases). The median survival was much less for malignant pathology (2·2 vs 8·7 years, Log rank P = 0·0009). In 2007, there were 59 patients that were presumed alive and 47 (80%) responded to the survey. Mean HbA1c at last follow-up was 7·5% with 89% of respondents on a complex insulin programme (mean daily insulin requirement 35 ± 13 units). Episodic hypoglycaemia was experienced by 37 (79%); 15 (41%) experienced severe hypoglycaemia. In contrast, diabetic ketoacidosis developed in only 2 (4%). Target organ complications and chronic diarrhoea developed in 13 patients (28%) each.


CONCLUSIONS
The primary factor determining survival after TP is the aetiology necessitating TP, i.e. pancreatic malignancy. Most respondents used complex insulin programmes, but hypoglycaemia continues to be a problem.
Parsaik
Ajay K
AK
Endocrinology, Mayo Clinic, Rochester, MN, USA.
Murad
Mohammad Hassan
MH
Sathananthan
Airani
A
Moorthy
Vetriselvi
V
Erwin
Patricia J
PJ
Chari
Suresh
S
Carter
Rickey E
RE
Farnell
Michael B
MB
Vege
S S
SS
Sarr
Michael G
MG
Kudva
Yogish C
YC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016883:Diabetic Ketoacidosis / Q000209:etiology; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology; D007328:Insulin / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome
D007328:Insulin