Assessment of exo- and endocrine function of pancreas following distal pancreatectomy

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Aim. The assessment of pancreatic resection volume influence on exo- and endocrine pancreatic functions.

Materials and methods. The resected pancreatic volume influence was assessed in 47 patients: 31 (66%) patients after resections of pancreatic body and tail, and 16 (34%) patients after distal resections. The exocrine pancreatic function was assessed by pancreatic fecal elastase 1 as well as endocrine pancreatic function was assessed by C-peptide level measurement. Computed tomography with intravenous contrast enhancement and postprocessing was used for pre- and postoperative pancreatic volume assessment. All tests were performed before and 1, 3, and 6 months after surgery.

Results. Type of surgery had no influence on C-peptide and pancreatic fecal elastase 1 levels (p>0.05). Exo- and endocrine pancreatic functions markers tended to decrease in 1st month after surgery with consequent functions restoration towards 6 months after surgery. There were 15 (35.7%) patients from 42 patients with normal exocrine pancreatic function with a fecal elastase 1 level decrease to 114.7±61.8 μg/g; exocrine insuficiency remained only in 2 (4.8%) patients after 6 months after surgery. C-peptide concentration decrease before surgery to less than 1.1 ng/ml was noticed only in 8 (17%) patients. C-peptide concentration decreased in 30 (63.8%) patients in 1st month after surgery, but after 6 months after surgery, C-peptide level decrease was only in 7 (14.9%) patients.

Conclusion. The exo- and endocrine function of the pancreas is restored in more than 80% of patients after DR. Probably it could be associated with the activation of the pancreatic compensatory abilities.

作者简介

Marina Malykh

Loginov Moscow Clinical Scientific and Practical Center

编辑信件的主要联系方式.
Email: m.malykh@mknc.ru
ORCID iD: 0000-0002-2480-5191

мл. науч. сотр. отд-ния патологии поджелудочной железы и желчевыводящих путей

俄罗斯联邦, Moscow

Elena Dubtsova

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0002-6556-7505

д-р мед. наук, зав. отд-нием патологии поджелудочной железы и желчных путей

俄罗斯联邦, Moscow

Lyudmila Vinokurova

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0002-4556-4681

д-р мед. наук, вед. науч. сотр. отд-ния патологии поджелудочной железы и желчевыводящих путей

俄罗斯联邦, Moscow

Konstantin Les’ko

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0001-9814-0172

канд. мед. наук, врач-рентгенолог рентгеновского отд-ния

俄罗斯联邦, Moscow

Alexey Dorofeev

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0002-8515-6658

мл. науч. сотр. лаб. научно-диагностических исследований

俄罗斯联邦, Moscow

Maria Kiryukova

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0002-6946-3826

мл. науч. сотр. отд-ния патологии поджелудочной железы и желчевыводящих путей

俄罗斯联邦, Moscow

Irina Savina

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0001-7142-3885

врач-гастроэнтеролог отд-ния патологии поджелудочной железы и желчевыводящих путей

俄罗斯联邦, Moscow

Victor Tsvirkun

Loginov Moscow Clinical Scientific and Practical Center

Email: m.malykh@mknc.ru
ORCID iD: 0000-0001-5169-2199

д-р мед. наук, проф., гл. науч. сотр.

俄罗斯联邦, Moscow

Dmitry Bordin

Loginov Moscow Clinical Scientific and Practical Center; Yevdokimov Moscow State University of Medicine and Dentistry; Tver State Medical University

Email: m.malykh@mknc.ru
ORCID iD: 0000-0003-2815-3992

д-р мед. наук, зав. отд. патологии поджелудочной железы, желчевыводящих путей и патологии верхних отделов пищеварительного тракта, проф. каф. пропедевтики внутренних болезней и гастроэнтерологии, проф. каф. поликлинической терапии и семейной медицины ФПДО

俄罗斯联邦, Moscow; Moscow; Tver

参考

  1. Марьянович А.Т. Общая теория пептидной регуляции физиологических функций: гематоэнцефалический барьер и эволюция связей между периферией и мозгом. СПб: Изд-во СЗГМУ им.И.И. Мечникова, 2014 [Mar'ianovich AT. Obshchaia teoriia peptidnoi reguliatsii fiziologicheskikh funktsii: gematoentsefalicheskii bar'er i evoliutsiia sviazei mezhdu periferiei i mozgom. Saint Petersburg: Izd-vo SZGMU im. I.I. Mechnikova, 2014 (in Russian)].
  2. Wang X, Misawa R, Zielinski MC, et al. Regional differences in islet distribution in the human pancreas-preferential beta-cell loss in the head region in patients with type 2 diabetes. PLoS One. 2013;8(6):e67454. doi: 10.1371/journal.pone.0067454
  3. Megibow AJ, Baker ME, Morgan DE, et al. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol. 2017;14(7):911-23. doi: 10.1016/j.jacr.2017.03.010
  4. Gaujoux S, Brennan MF, Gonen M, et al. Cystic lesions of the pancreas: changes in the presentation and management of 1,424 patients at a single institution over a 15-year time period. J Am Coll Surg. 2011;212(4):590-600. doi: 10.1016/j.jamcollsurg.2011.01.016
  5. Birkmeyer JD, Finlayson SR, Tosteson AN, et al. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125(3):250-6.
  6. Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic Adenocarcinoma, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(4):439-57. doi: 10.6004/jnccn.2021.0017
  7. Хатьков И.Е., Маев И.В., Абдулхаков С.Р., и др. Российский консенсус по экзо- и эндокринной недостаточности поджелудочной железы после хирургического лечения. Терапевтический архив. 2018;90(8):13-26 [Khatkov IE, Maev IV, Abdulkhakov SR, et al. Russian consensus on exoand endocrine pancreatic insufficiency after surgical treatment. Terapevticheskii Arkhiv (Ter. Arkh.). 2018;90(8):13-26 (in Russian)]. doi: 10.26442/terarkh201890813-26
  8. Löhr JM, Dominguez-Munoz E, Rosendahl J, et al; HaPanEU/UEG Working Group. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United Eur Gastroenterol J. 2017;5(2):153-99. doi: 10.1177/2050640616684695
  9. Sabater L, Ausania F, Bakker OJ, et al. Evidence-based Guidelines for the Management of Exocrine Pancreatic Insufficiency After Pancreatic Surgery. Ann Surg. 2016;264(6):949-58. doi: 10.1097/SLA.0000000000001732
  10. Goess R, Ceyhan GO, Friess H. Pancreatic exocrine insufficiency after pancreatic surgery. Panminerva Med. 2016;58(2):151-9.
  11. Gilliland TM, Villafane-Ferriol N, Shah KP, et al. Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection. Nutrients. 2017;9(3):243. doi: 10.3390/nu9030243
  12. Lekkerkerker SJ, Hoogenboom SA, et al. Correlation Between the Standard Pancreatic Elastase-1 Enzyme-Linked Immunosorbent Assay Test and the New, Rapid Fecal Pancreatic Elastase-1 Test for Diagnosing Exocrine Pancreatic Insufficiency. Pancreas. 2019;48(4):e26-e27. doi: 10.1097/MPA.0000000000001291
  13. Lim JH, Park JS, Yoon DS. Preoperative Fecal elastase-1 Is a Useful Prognostic Marker Following Curative Resection of Pancreatic Cancer. HPB (Oxford). 2017;19(5):388-95. doi: 10.1016/j.hpb.2016.12.007
  14. Yepuri N, Naous R, Meier AH, et al. A systematic review and meta-analysis of predictors of recurrence in patients with Solid Pseudopapillary Tumors of the Pancreas. HPB (Oxford). 2020;22(1):12-9. doi: 10.1016/j.hpb.2019.06.005
  15. Лебедева А.Н. Хирургическое лечение заболеваний поджелудочной железы: метаболические последствия, диагностика и периоперационное ведение, прогноз. Автореф. дис. … д-ра мед. наук. М., 2017 [Lebedeva AN. Khirurgicheskoe lechenie zabolevanii podzheludochnoi zhelezy: metabolicheskie posledstviia, diagnostika i perioperatsionnoe vedenie, prognoz. Avtoref. dis. … d-ra med. nauk. Moscow, 2017 (in Russian)].
  16. Slezak LA, Andersen DK. Pancreatic resection: effects on glucose metabolism. World J Surg. 2001;25(4):452-60. doi: 10.1007/s002680020337
  17. Domínguez-Muñoz JE, D Hardt P, Lerch MM, Löhr MJ. Potential for Screening for Pancreatic Exocrine Insufficiency Using the Fecal Elastase-1 Test. Dig Dis Sci. 2017;62(5):1119-30. doi: 10.1007/s10620-017-4524-z
  18. Löser C, Möllgaard A, Fölsch UR. Faecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test. Gut. 1996;39(4):580-6. doi: 10.1136/gut.39.4.580
  19. King J, Kazanjian K, Matsumoto J, et al. Distal pancreatectomy: incidence of postoperative diabetes. J Gastrointest Surg. 2008;12(9):1548-53. doi: 10.1007/s11605-008-0560-5
  20. Hart PA, Bellin MD, Andersen DK, et al; Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer(CPDPC). Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol. 2016;1(3):226-37. doi: 10.1016/S2468-1253(16)30106-6
  21. Speicher JE, Traverso LW. Pancreatic exocrine function is preserved after distal pancreatectomy. J Gastrointest Surg. 2010;14(6):1006-11. doi: 10.1007/s11605-010-1184-0

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2. Fig. 1. CT processing: a – preoperative analysis. Axial CT scan, late arterial (pancreatic) phase: green – pancreatic remnant, red – resected part; b – CT scan at 6 months after the operation. Axial CT scan, late arterial (pancreatic) phase: green – pancreatic remnant.

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3. Fig. 2. Values of the volume of removed pancreatic tissue depending on the type of operation.

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4. Fig. 3. Fecal pancreatic elastase-1 concentration values in the pre- and postoperative period.

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5. Fig. 4. Serum C-peptide concentrations in the pre- and postoperative period.

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6. Fig. 5. Changes in the concentration of C-peptide and fecal pancreatic elastase-1 in the pre- and postoperative period.

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