The atrophy of remnant pancreas after pancreatoduodenectomy

Abstract

Background/Aim Remnant pancreas atrophy after pancreatoduodenectomy has been reported in previous studies. However, the factors aggravating atrophy and the effects of the atrophy were not studied well. The aim of this study was to evaluate the clinical factors to affect remnant pancreas atrophy and to assess effects of atrophy on quality of life, nutritional status and pancreatic exocrine/endocrine functions. Methods Prospectively collected data of 122 patients who completed 12 months follow-up with CT and quality of life questionnaire after pancreaticoduodenectomy were analyzed. Preoperative, remnant and 12 months follow-up pancreas volume were measured using CT volumetry program. Patients were divided into 2 groups. Group I was the patients with pancreas volume decrease under 50% and group II was the patients with pancreas volume decrease over 50% at 12 months. The patients with preoperative diabetes were excluded in endocrine function analysis. Results The volume of remnant pancreas decreased about 45% during 12 months after operation. Malignancy and adjuvant chemoradiotherapy were significantly associated with volume decrease over 50% in multivariate analysis. Mostly of quality of life scores and nutritional indexes at 12 months were not significantly associated with the atrophy. However, stool elastase was significantly more decreased in group II (33.6 µg/g vs. 104.1 µg/g, p=0.003). In group I, 14.6% of patients showed no exocrine deficiency (stool elastase ≥ 200 µg/g) and 78.0% of patients showed severe exocrine deficiency (stool elastase < 100 µg/g). In group II, 92.0% of patients had severe exocrine deficiency and there was no patient with normal exocrine function. Diabetes at 12 months were more frequently detected in group II (26.8% vs. 10.5%, p=0.057). Serum fasting blood glucose level was not different between 2 groups, but postprandial 2-hour blood glucose was significantly higher in group II (163.7 mg/dl vs. 133.6 mg/dl, p=0.035) and glycosylated hemoglobin level showed higher tendency in group II (6.0% vs. 5.7%, p=0.088). Conclusions The atrophy of remnant pancreas after pancreatoduodenectomy was more severe in the patients with malignancy and who underwent adjuvant chemoradiotherapy. The quality of life and nutritional status were not significantly affected by the remnant pancreas atrophy, however, exocrine and endocrine function were associated with the atrophy. More careful monitoring and active management of exocrine and endocrine deficiency will be needed in the patients who underwent pancreatoduodenectomy due to malignancy and who carried out adjuvant chemoradiotherapy.