Long-term results of distal pancreatectomy for chronic pancreatitis in 90 patients

Changes in glucose metabolism after distal pancreatectomy: a nationwide database study

Background

This population-based study evaluated changes in glucose metabolism after distal pancreatectomy (DP).

Methods

Data from the Taiwan National Health Insurance Research Database was collected from 2001 to 2010. Of 1,980 patients who underwent DP, 507 had diabetes and 1,410 did not.

Results

Of the 1,410 non-diabetic pre-DP patients, 312 (22.1%) developed newly-diagnosed diabetes after DP. Multiple logistic regression analysis revealed that dyslipidemia [hazard ratio = 1.940; 95% confidence interval = 1.362–2.763; P < 0.001] and chronic pancreatitis (hazard ratio = 2.428; 95% confidence interval = 1.889–3.121; P < 0.001) were significantly associated with the development of diabetes after DP. On the other hand, analysis of changes in glucose metabolism among 289 pre-DP diabetes without the use of insulin revealed that 173 (59.9%) had deteriorated glucose metabolism after DP.

Conclusion

Dyslipidemia and chronic pancreatitis are risk factors for the development of diabetes. Further, more than half of the pre-DP diabetes patients without the use of insulin had deterioration of glucose metabolism after DP. Therefore, clinicians should monitor glucose metabolism and clinical symptoms of hyperglycemia among DP patients.

Preventing pancreatic fistula after distal pancreatectomy: An invagination method

Following an increase in the use of the GIA stapler for treating a pancreatic stump, more techniques to prevent postoperative pancreatic juice leakage have been required. We describe one successful case using our new technique of invaginating the cut end of the pancreas into the stomach to prevent a pancreatic fistula (PF) from occurring. A 50-year-old woman with pancreatic cancer in the tail of the pancreas underwent distal pancreatectomy, causing a grade A PF. We resected the distal pancreas without additional reinforcement to invaginate the stump into the gastric posterior wall with single layer anastomosis using a 3-0 absorbable suture. The drain tubes were removed on the third postoperative day. Although a grade A PF was noted, the patient was discharged on foot on the eleventh postoperative day. Our technique may be a suitable method for patients with a pancreatic body and tail tumor.

Combined laparoscopic spleen-preserving distal pancreatectomy and islet autotransplantation for benign pancreatic neoplasm

AIM: To evaluate the safety and feasibility of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with autologous islet transplantation (AIT) for benign tumors of the pancreatic body-neck.

METHODS: Three non-diabetic, female patients (age 37, 44 and 35 years, respectively) were declared candidates for surgery, between May and September 2011, because of pancreatic body/neck cystic lesions. The planned operation was an LSPDP associated with AIT from the normal pancreas distal to the neoplasm. Islets isolation was performed on the residual pancreatic parenchyma after frozen section examination of the margin. Purified autologous islets were infused into the portal vein by a percutaneous transhepatic approach the day after surgery.

RESULTS: The procedure was performed successfully in all the three cases, and the spleen was preserved along with its vessels. Mean operation time was 283 ± 52 min and average blood loss was 133 ± 57 mL. Residual pancreas weights were 33, 22 and 30 g, and 105.200, 40.390 and 94.790 islet equivalents were isolated, respectively. Surgical complications occurred in one patient (grade A pancreatic fistula). Postoperative stays were 6, 6 and 7 d, respectively. Histopathological evaluation revealed mucinous cystic neoplasm in cases 1 and 3, and serous cystic neoplasm in patient 2. No postoperative insulin administration was required. One patient developed a transient partial portal thrombosis 2 mo after islet infusion. Patients are insulin independent at a mean follow up of 8 ± 2 mo.

CONCLUSION: Combination of LSPDP and AIT is feasible and could be effective to minimize the surgical impact for benign neoplasm of pancreatic body-neck.