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Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy.
Pancreas. 2007 Nov; 35(4):361-5.P

Abstract

OBJECTIVES

Pancreatic exocrine insufficiency has been reported to be more common in pancreaticogastrostomy (PG) than in pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). This study aimed to evaluate the long-term outcome after PD between these 2 groups.

METHODS

We evaluated the long-term functional status of 42 surviving patients diagnosed with periampullary lesions who underwent PJ or PG after PD and followed up for more than 1 year. Among these, 23 patients underwent PJ and 19 patients underwent PG. To compare the 2 groups, we analyzed the (1) pancreatic exocrine insufficiency by questioning the presence or absence of steatorrhea, (2) pancreatic endocrine function by measuring glycohemoglobin A1c, fasting blood glucose, and history of new-onset diabetes, (3) nutritional status by measuring serum total protein, albumin, cholesterol, and triglyceride, (4) gastric emptying time, (5) panendoscopic findings, (6) changes of pancreatic duct diameter by computed tomography, and (7) relaparotomy rate.

RESULTS

The mean follow-up time for PG and PJ were 37 +/- 23 and 103 +/- 52 months, respectively (P < 0.05). A total of 52.4% patients developed pancreatic exocrine insufficiency, and 11.9% had new-onset diabetes. There was no significant difference between PJ and PG groups. A significantly improved postoperative nutritional state regarding serum total protein and albumin were noticed in both groups. There was no significant difference in terms of gastric emptying time, positive panendoscopic findings, and changes in pancreatic duct diameter. The pancreatic remnant-related relaparotomy rate was higher in the PJ group as compared with the PG group (17.4% vs 0%; P = 0.056).

CONCLUSIONS

There is no significant difference in pancreatic exocrine or endocrine insufficiency, gastric emptying time, and positive panendoscopic findings between PJ and PG. Pancreaticojejunostomy was associated with a higher pancreatic remnant-related relaparotomy rate; however, because of a shorter follow-up in the PG group, a continuous long-term follow-up is still needed.

Authors+Show Affiliations

Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18090244

Citation

Fang, Wen-Liang, et al. "Functional and Morphological Changes in Pancreatic Remnant After Pancreaticoduodenectomy." Pancreas, vol. 35, no. 4, 2007, pp. 361-5.
Fang WL, Su CH, Shyr YM, et al. Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy. Pancreas. 2007;35(4):361-5.
Fang, W. L., Su, C. H., Shyr, Y. M., Chen, T. H., Lee, R. C., Tai, L. C., Wu, C. W., & Lui, W. Y. (2007). Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy. Pancreas, 35(4), 361-5.
Fang WL, et al. Functional and Morphological Changes in Pancreatic Remnant After Pancreaticoduodenectomy. Pancreas. 2007;35(4):361-5. PubMed PMID: 18090244.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional and morphological changes in pancreatic remnant after pancreaticoduodenectomy. AU - Fang,Wen-Liang, AU - Su,Cheng-Hsi, AU - Shyr,Yi-Ming, AU - Chen,Tien-Hua, AU - Lee,Rheun-Chuan, AU - Tai,Ling-Chen, AU - Wu,Chew-Wun, AU - Lui,Wing-Yiu, PY - 2007/12/20/pubmed PY - 2008/1/30/medline PY - 2007/12/20/entrez SP - 361 EP - 5 JF - Pancreas JO - Pancreas VL - 35 IS - 4 N2 - OBJECTIVES: Pancreatic exocrine insufficiency has been reported to be more common in pancreaticogastrostomy (PG) than in pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD). This study aimed to evaluate the long-term outcome after PD between these 2 groups. METHODS: We evaluated the long-term functional status of 42 surviving patients diagnosed with periampullary lesions who underwent PJ or PG after PD and followed up for more than 1 year. Among these, 23 patients underwent PJ and 19 patients underwent PG. To compare the 2 groups, we analyzed the (1) pancreatic exocrine insufficiency by questioning the presence or absence of steatorrhea, (2) pancreatic endocrine function by measuring glycohemoglobin A1c, fasting blood glucose, and history of new-onset diabetes, (3) nutritional status by measuring serum total protein, albumin, cholesterol, and triglyceride, (4) gastric emptying time, (5) panendoscopic findings, (6) changes of pancreatic duct diameter by computed tomography, and (7) relaparotomy rate. RESULTS: The mean follow-up time for PG and PJ were 37 +/- 23 and 103 +/- 52 months, respectively (P < 0.05). A total of 52.4% patients developed pancreatic exocrine insufficiency, and 11.9% had new-onset diabetes. There was no significant difference between PJ and PG groups. A significantly improved postoperative nutritional state regarding serum total protein and albumin were noticed in both groups. There was no significant difference in terms of gastric emptying time, positive panendoscopic findings, and changes in pancreatic duct diameter. The pancreatic remnant-related relaparotomy rate was higher in the PJ group as compared with the PG group (17.4% vs 0%; P = 0.056). CONCLUSIONS: There is no significant difference in pancreatic exocrine or endocrine insufficiency, gastric emptying time, and positive panendoscopic findings between PJ and PG. Pancreaticojejunostomy was associated with a higher pancreatic remnant-related relaparotomy rate; however, because of a shorter follow-up in the PG group, a continuous long-term follow-up is still needed. SN - 1536-4828 UR - https://www.unboundmedicine.com/medline/citation/18090244/Functional_and_morphological_changes_in_pancreatic_remnant_after_pancreaticoduodenectomy_ L2 - https://doi.org/10.1097/MPA.0b013e3180d0a8d5 DB - PRIME DP - Unbound Medicine ER -