The morphological and functional evolution of the remnant pancreas after resection for pancreatic adenocarcinoma

초록

Background: Little is known about the evolution of the remnant pancreas after resection for pancreatic adenocarcinoma. The morphological and functional change and trends are important for patient counselling and management planning. Methods: The data for the consecutive patients who had undergone pancreatic resection for adenocarcinoma with curative intent in Inha University Hospital from March, 2010 to September, 2013 were reviewed retrospectively. The endocrine function was measured by the daily maximum serum glucose fluctuation divided by daily minimum glucose (Gmax - G min, ΔG) / Gmin. The pancreas atrophy was measured by the ratio of pancreatic duct width to the total pancreas width (PDW/ TPW). The remnant pancreas volume (V) was measured by simulating to a cone π/3 x (Thickness/2) x (Depth/2) x (Length), as measured on the computed tomography scan. T-tests were used to compare means, and Wilcoxon’s signed rank test was used where appropriate. Results: A total of 46 patients were enrolled. There were 29 men and 17 women, with a male to female ration of 1.7:1. Thirty five patients had received pancreaticoduodenectomy, while 10 patients had undergone distal or near total pancreatectomy, and one patient received total pancreatectomy. The ΔG/Gmin increased significantly at postoperative one day (p=0.007), then decreased below the preoperative level at postoperative 7, 14 days, respectively (p=0.000, 0.035), and stayed stable, thereafter (p=0.419). PDW/TPW decreased below 0.5 at the first postoperative months as compared to the preoperative value (p=0.000), and no significant change was observed since. V significantly decreased at postoperative 1 month (p=0.017), and then there was no further significant change. Conclusions: The pancreatic endocrine function after resection for pancreas adenocarcinoma deteriorates during immediate postoperative days, but resumes the preoperative level by 7 days. Likewise, pancreatic atrophy and remnant pancreas volume decreased