Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy

Abstract

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.

Keywords: Distal pancreatectomy; Pancreatic endocrine insufficiency; Pancreatic enzyme replacement; Pancreatic exocrine insufficiency; Pancreaticoduodenectomy.

Figure 1:

Figure 1a: Cumulative incidence of endocrine insufficiency. 20.15% of patients developed endocrine insufficiency at mean 20.80 months follow-up. Figure 1b: Cumulative incidence of endocrine insufficiency by diabetes type (IDDM = insulin-dependent diabetes mellitus, NIDDM = non-insulin dependent diabetes mellitus)

Figure 1:

Figure 1a: Cumulative incidence of endocrine insufficiency. 20.15% of patients developed endocrine insufficiency at mean 20.80 months follow-up. Figure 1b: Cumulative incidence of endocrine insufficiency by diabetes type (IDDM = insulin-dependent diabetes mellitus, NIDDM = non-insulin dependent diabetes mellitus)

Figure 2:

Cumulative incidence of exocrine insufficiency. 36.23% of patients developed exocrine insufficiency at mean 14.20 months follow-up.