title: Metabolic consequences of the occlusion of the main pancreatic duct with acrylic glue after pancreaticoduodenectomy.
abstract: BACKGROUND
  Pancreaticoduodenectomy represents the major treatment for pancreatic and periampullary neoplasms. Complications related to pancreaticojejunostomy are still the leading cause of morbidity and mortality. A solution proposed by some surgeons is the occlusion of main pancreatic duct by acrylic glue, avoiding pancreaticojejunostomy. Nevertheless, the consequences of this procedure on glucose metabolism are not well-defined.
  
  
  METHODS
  We retrospectively analyzed a cohort of 50 patients who underwent pancreaticoduodenectomy and had metabolic assessments available. The metabolic evaluation included the following: body composition and clinical evaluation, an oral glucose tolerance test, and an hyperinsulinemic euglycemic clamp procedure.
  
  
  RESULTS
  Twenty-three patients underwent pancreatic duct occlusion and were compared with 27 patients, well-matched controls, who underwent pancreaticojejunostomy. Pancreatic duct occlusion leads to a greater impairment in insulin secretion compared with classic pancreaticojeunostomy.
  
  
  CONCLUSIONS
  Pancreatic duct occlusion is associated with a greater reduction in insulin secretion but does not lead to meaningful differences in the management of patients with diabetes.
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Mezza
authors.affiliation: Department of Surgical Sciences, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy. Electronic address: gclemente@rm.unicatt.it.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Clemente
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Gian Pio
authors.initials: GP
authors.lastname: Sorice
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Conte
authors.affiliation: Department of Surgical Sciences, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Agostino Maria
authors.initials: AM
authors.lastname: De Rose
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Vincin Alice
authors.initials: VA
authors.lastname: Sun
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Chiara Maria Assunta
authors.initials: CM
authors.lastname: Cefalo
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Pontecorvi
authors.affiliation: Department of Surgical Sciences, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Nuzzo
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Catholic University of Sacred Heart, A. Gemelli Medical School, L.go Gemelli 8, Rome 00168, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giaccari
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003138:Common Bile Duct Neoplasms / Q000378:metabolism / Q000601:surgery; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004379:Duodenal Neoplasms / Q000378:metabolism / Q000601:surgery; D005260:Female; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D003487:Cyanoacrylates; D007328:Insulin; C421461:glubran 2
keywords: Insulin secretion; Metabolic evaluation; Pancreatic duct occlusion; Pancreaticoduodenectomy; Pancreaticojejunostomy