Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection

• Published in: HPB (Oxford, England) England), 2016-04, Vol.18 (4), p.360-366
• Main Authors: Lim, Pei-Wen, Dinh, Kate H, Sullivan, Mary, Wassef, Wahid Y, Zivny, Jaroslav, Whalen, Giles F, LaFemina, Jennifer
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant - adverse effects; Databases, Factual; Exocrine Pancreatic Insufficiency - diagnosis; Exocrine Pancreatic Insufficiency - drug therapy; Exocrine Pancreatic Insufficiency - etiology; Exocrine Pancreatic Insufficiency - physiopathology; Female; Gastroenterology and Hepatology; Humans; Hypoglycemic Agents - therapeutic use; Islets of Langerhans - drug effects; Islets of Langerhans - pathology; Islets of Langerhans - physiopathology; Islets of Langerhans - surgery; Male; Middle Aged; Original; Pancreas, Exocrine - drug effects; Pancreas, Exocrine - pathology; Pancreas, Exocrine - physiopathology; Pancreas, Exocrine - surgery; Pancreatectomy - adverse effects; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Radiotherapy, Adjuvant - adverse effects; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Young Adult
• ISSN: 1365-182X; 1477-2574
• DOI: 10.1016/j.hpb.2015.11.003

Abstract Background Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy. Methods Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227). Subjects who underwent total pancreatectomy or pancreatitis surgery were excluded. New post-operative endocrine and exocrine insufficiency was defined as the need for new pharmacologic intervention within 1000 days from resection. Results 28 (16%) of 178 subjects without pre-existing endocrine insufficiency developed post-operative endocrine insufficiency: 7 (25%) did so within 30 days, 8 (29%) between 30 and 90 days, and 13 (46%) after 90 days. 94 (43%) of 214 subjects without pre-operative exocrine insufficiency developed exocrine insufficiency: 20 (21%) did so within 30 days, 29 (31%) between 30 and 90 days, and 45 (48%) after 90 days. Adjuvant radiation was associated with new endocrine insufficiency. On multivariate regression, pancreaticoduodenectomy and chemotherapy were associated with a greater risk of exocrine insufficiency. Conclusion Reporting 30-day functional outcomes for pancreatic resection is insufficient, as nearly 45% of subjects who develop disease do so after 90 days. Reporting of at least 90-day outcomes may more reliably assess risk for post-operative endocrine and exocrine insufficiency.