Background: Long-term pancreatic function after pancreatectomy is not well described, but is important for both pre-operative risk assessment and counseling having both short- and long- term health consequences. The objective of this study was to identify risk factors for pancreatic exocrine and endocrine insufficiency after pancreatectomy.
Methods: We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) from 2000 – 2017. Exocrine and endocrine insufficiency were defined as the need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative exocrine and endocrine insufficiency.
Results: 1,632 patient records were analyzed (74% PD, 26% DP). Average age was 65 years, 51% were male, and surgery was for malignancy in 74% of patients. Median follow-up for all patients was 16 months. Post-operative exocrine insufficiency was present in 31% of patients. Race, body mass index (BMI), family history of diabetes, malignant pathology, steatorrhea, and PD were correlated with an increased risk of exocrine insufficiency. Post-operative endocrine insufficiency was present in 16% of patients. BMI, tobacco use, family history of diabetes, personal history of diabetes, pancreatitis, pre-operative diabetes, and PD were correlated with an increased risk of endocrine insufficiency. Median time to onset of exocrine and endocrine insufficiency were 53 and 98 days, respectively.
Conclusion: In this large series of pancreatectomy patients, 31% and 16% developed post- operative exocrine and endocrine insufficiency, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness for onset within the first 100 days after surgery.
Table 1Multivariate analysis of exocrine and endocrine function post pancreaticoduodenectomy (PD) and distal pancreatectomy (DP)
| p value | Hazard ratio | 95% Confidence interval | |||
|---|---|---|---|---|---|
| Exocrine insufficiency | Race (Caucasian vs. Other) | 0.0427 | 1.369 | 1.010 | 1.855 |
| Body mass index (BMI) | 0.0004 | 0.970 | 0.954 | 0.987 | |
| Family history of diabetes | 0.0008 | ||||
| Yes vs. No | 1.279 | 1.028 | 1.592 | ||
| Unknown vs. No | 0.834 | 0.662 | 1.051 | ||
| Malignant vs. benign | 0.0325 | 1.289 | 1.021 | 1.627 | |
| Steatorrhea (Yes vs. No) | 0.0003 | 1.448 | 1.183 | 1.773 | |
| PD vs. DP | <.0001 | 1.994 | 1.510 | 2.633 | |
| Endocrine insufficiency | Body mass index (BMI) | 0.0455 | 1.018 | 1.000 | 1.036 |
| Tobacco | 0.0187 | ||||
| Smoker vs. Non-smoker | 1.092 | 0.778 | 1.534 | ||
| Ex-smoker vs. Non- smoker | 1.496 | 1.121 | 1.998 | ||
| Family history of diabetes | 0.0103 | ||||
| Yes vs. No | 1.483 | 1.081 | 2.034 | ||
| Unknown vs. No | 0.987 | 0.694 | 1.403 | ||
| Personal history of diabetes | 0.0001 | ||||
| Type 1 vs. None | 1.041 | 0.423 | 2.563 | ||
| Type 2 vs. None | 3.152 | 2.419 | 4.108 | ||
| Pancreatitis (Yes vs. No) | 0.0048 | 1.556 | 1.144 | 2.117 | |
| PD vs. DP | <.0001 | 0.443 | 0.339 | 0.579 | |
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