Metabolic consequences of a 50% partial pancreatectomy in humans

• Published in: Diabetologia 2009-02, Vol.52 (2), p.306-317
• Main Authors: Menge, B. A, Schrader, H, Breuer, T. G. K, Dabrowski, Y, Uhl, W, Schmidt, W. E, Meier, J. J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Beta cell mass; Biological and medical sciences; Blood Glucose - metabolism; Blood Pressure; Carcinoma - blood; Carcinoma - surgery; Carcinoma, Pancreatic Ductal - blood; Carcinoma, Pancreatic Ductal - surgery; Chronic pancreatitis; Diabetes; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Gastroenterology. Liver. Pancreas. Abdomen; Glucose; Glucose Tolerance Test; Glycated Hemoglobin A - metabolism; Homeostasis; Hospitals; Human Physiology; Humans; Insulin - blood; Insulin - metabolism; Insulin resistance; Insulin Secretion; Insulin-Secreting Cells - metabolism; Internal Medicine; Leukocyte Count; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; Middle Aged; Oral glucose tolerance; Other diseases. Semiology; Pancreatectomy; Pancreatectomy - methods; Pancreatic cancer; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - surgery; Pancreatitis; Pancreatitis, Chronic - blood; Pancreatitis, Chronic - surgery; Peptides; Surgery; Tumors
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-008-1219-1

Aims/hypothesis Partial pancreatectomy is frequently performed in patients with pancreatic tumours or chronic pancreatitis, but little is known about the metabolic impact of this intervention. We examined the effects of approximately 50% partial pancreatectomy on glucose homeostasis and insulin secretion. Methods Fourteen patients with chronic pancreatitis, ten patients with pancreatic carcinoma and 13 patients with benign pancreatic tumours or extra-pancreatic masses (control group) underwent 240 min oral glucose tolerance tests before and after pancreatic tail-resection (n = 12), duodenopancreatectomy (n = 19) or duodenum-preserving pancreatic-head resection (n = 6). Results Partial pancreatectomy led to a reduction in post-challenge insulin excursions by 49% in chronic pancreatitis patients, 52% in carcinoma patients and 55% in controls (p < 0.05). Nevertheless, post-challenge glucose concentrations were transiently ameliorated after surgery (p < 0.001). In the control participants, pancreatic-head resection caused a transient reduction of post-challenge glycaemia, whereas pancreatic-tail resection increased both fasting and post-challenge glycaemia (p < 0.05). Insulin sensitivity was highest in chronic pancreatitis patients before surgery (p < 0.01), but remained unchanged by the partial pancreatectomy. High pre-operative body weight and elevated fasting glucose levels were associated with poor glycaemic control after surgery. Conclusions/interpretation Insulin secretion is diminished after pancreatic-head and -tail resection, but post-challenge glucose concentrations can be ameliorated after pancreatic-head resection. These data highlight the unequal impact of different surgical procedures on glucose control and suggest that obesity and high pre-operative glucose levels should be considered as risk factors for the development of hyperglycaemia after pancreatic surgery.