title: The impact of pancreatic resection on exocrine homeostasis.
abstract: Patients undergoing pancreatic resection are at risk for developing postoperative exocrine dysfunction. We sought to determine the incidence of and clinical factors associated with exocrine dysfunction after pancreatectomy. A retrospective review of a prospective database composed of patients undergoing pancreatic resection between 2004 and 2013 was performed. Logistic regression was used to identify preoperative factors that influenced postoperative exocrine insufficiency. One hundred sixty-one patients with complete follow-up were identified. The mean age was 64.1 ± 12.65 years. The majority were: female (51%), white (66%), tobacco users (61%), nondrinkers (68%), nondiabetic (71%), and without preoperative exocrine dysfunction (96%). Average body mass index was 27.8 ± 6.32 kg/m(2). Most underwent a pancreaticoduodenectomy (67.3%) for pancreatic cancer (59.6%). Pancreatic fistula occurred in 6.8 per cent. Seven patients were on enzyme replacement therapy preoperatively. Forty-four patients (27%) had postoperative exocrine dysfunction (five of whom were on enzyme replacement therapy preoperatively). Two of seven (29%) of patients with preoperative exocrine dysfunction had complete resolution of their exocrine dysfunction. On univariate analysis, only the type of operation (Whipple) was significantly associated with exocrine dysfunction (P = 0.04). On multivariate analysis, both female gender and type of operation were independently associated with postoperative exocrine dysfunction (P = 0.05). Pancreatic exocrine dysfunction occurred less frequently in this population than what is commonly reported in the literature. Female patients undergoing resection of the pancreatic head have significantly increased risk of exocrine dysfunction.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, The Brody School of Medicine, East Carolina, University, Greenville, North Carolina, USA.
authors.forename: Swapnil D
authors.initials: SD
authors.lastname: Kachare
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Fitzgerald
authors.forename: Olga
authors.initials: O
authors.lastname: Schuth
authors.forename: Nasreen A
authors.initials: NA
authors.lastname: Vohra
authors.forename: Emmanuel E
authors.initials: EE
authors.lastname: Zervos
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D010188:Exocrine Pancreatic Insufficiency / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012423:Rural Health; D055815:Young Adult