title: Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection.
abstract: BACKGROUND
  Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy.
  
  
  METHODS
  Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227). Subjects who underwent total pancreatectomy or pancreatitis surgery were excluded. New post-operative endocrine and exocrine insufficiency was defined as the need for new pharmacologic intervention within 1000 days from resection.
  
  
  RESULTS
  28 (16%) of 178 subjects without pre-existing endocrine insufficiency developed post-operative endocrine insufficiency: 7 (25%) did so within 30 days, 8 (29%) between 30 and 90 days, and 13 (46%) after 90 days. 94 (43%) of 214 subjects without pre-operative exocrine insufficiency developed exocrine insufficiency: 20 (21%) did so within 30 days, 29 (31%) between 30 and 90 days, and 45 (48%) after 90 days. Adjuvant radiation was associated with new endocrine insufficiency. On multivariate regression, pancreaticoduodenectomy and chemotherapy were associated with a greater risk of exocrine insufficiency.
  
  
  CONCLUSIONS
  Reporting 30-day functional outcomes for pancreatic resection is insufficient, as nearly 45% of subjects who develop disease do so after 90 days. Reporting of at least 90-day outcomes may more reliably assess risk for post-operative endocrine and exocrine insufficiency.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Pei-Wen
authors.initials: PW
authors.lastname: Lim
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Kate H
authors.initials: KH
authors.lastname: Dinh
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Sullivan
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Wahid Y
authors.initials: WY
authors.lastname: Wassef
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Zivny
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Giles F
authors.initials: GF
authors.lastname: Whalen
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Massachusetts Medical School, Worcester, MA, USA. Electronic address: jennifer.lafemina@umassmemorial.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: LaFemina
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D016208:Databases, Factual; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents