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Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy
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Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy
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Journal Article
Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy
2019
Overview
Purpose
To identify peri-operative risk factors and time to onset of pancreatic endocrine/exocrine insufficiency.
Methods
We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2000 and 2015. Endocrine/exocrine insufficiencies were defined as need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative pancreatic insufficiency.
Results
A total of 1717 patient records were analyzed (75.47% PD, 24.53% DP) at median follow-up 17.88 months. Average age was 62.62 years, 51.78% were male, and surgery was for malignancy in 74.35% of patients. Post-operative endocrine insufficiency was present in 20.15% (
n
= 346). Male gender (
p
= 0.015), increased body mass index (BMI) (
p
< 0.001), tobacco use (
p
= 0.011), family history of diabetes (DM) (
p
< 0.001), personal history of DM (
p ≤
0.001), and DP (
p ≤
0.001) were correlated with increased risk. Mean time to onset was 20.80 ± 33.60 (IQR: 0.49–28.37) months. Post-operative exocrine insufficiency was present in 36.23% (
n
= 622). Race (
p
= 0.014), lower BMI (
p
< 0.001), family history of DM (
p
= 0.007
)
, steatorrhea (
p
< 0.001), elevated pre-operative bilirubin (
p
= 0.019), and PD (
p ≤
0.001) were correlated with increased risk. Mean time to onset was 14.20 ± 26.90 (IQR: 0.89–12.69) months.
Conclusions
In this large series of pancreatectomy patients, 20.15% and 36.23% of patients developed post-operative endocrine and exocrine insufficiency at a mean time to onset of 20.80 and 14.20 months, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness long-term.
Publisher
Springer US,Springer Nature B.V
