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Small amounts of tissue preserve pancreatic function

View Article: PubMed Central - PubMed

ABSTRACT

Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear.

The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP.

From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires.

Our case series included 3 women and 2 men, with median age of 50 (37–81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250–615) min and 800 (400–5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency.

In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.

No MeSH data available.


Pancreatic endocrine function including OGTT and beta-cell function tests during long-term follow-up studies. (A) OGTT; (B) OGTT insulin release curve; (C) OGTT C-peptide release curve; (D–F) comparison of beta-cell function parameters including HOMA2-Beta (cp), AUC for C-peptide and C-peptide index between patients after TP, MPP, and PD. AUC = area under the curve, HOMA2-beta = modified homeostasis model assessment of beta-cell function, MPP = middle-segment preserving pancreatectomy, OGTT = oral glucose tolerance test, PD = pancreaticoduodenectomy, TP = total pancreatectomy.
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Figure 3: Pancreatic endocrine function including OGTT and beta-cell function tests during long-term follow-up studies. (A) OGTT; (B) OGTT insulin release curve; (C) OGTT C-peptide release curve; (D–F) comparison of beta-cell function parameters including HOMA2-Beta (cp), AUC for C-peptide and C-peptide index between patients after TP, MPP, and PD. AUC = area under the curve, HOMA2-beta = modified homeostasis model assessment of beta-cell function, MPP = middle-segment preserving pancreatectomy, OGTT = oral glucose tolerance test, PD = pancreaticoduodenectomy, TP = total pancreatectomy.

Mentions: In order to further evaluate the endocrine function of preserved pancreatic tissue, we measured serum insulin and C-peptide levels after OGTT (Fig. 3A–C). Insulin levels varied from 0.60 to 16.10 mIU/L for the base value and 4.9 to 35.5 mIU/L for the peak value, while C-peptide ranged from 47.9 to 445 pmol/L and 282 to 2185 pmol/L for base and peak values, respectively. Peak time was 30 to 120 and 60 to 180 min, while the ratio of peak/base value ranged from 1.3 to 57.3 and 2.9 to 10.6 for insulin and C-peptide release, respectively. Cases 1 and 2 showed a peakless release curve at a low level, which was in accordance with their diabetic status. Case 4 showed a delayed peak (peak time 120 min) release curve with a slightly lower peak/base ratio. Cases 3 and 5 had a normal release curve (Table 4; Fig. 3A–C). Beta-cell function was further evaluated with HOMA2-beta (cp), AUC for C-peptide and CPI, and was compared to values measured after TP or PD. Results showed that insulin secretion was at the lowest level after TP, and MPP seemed to have a better endocrine function in comparison to TP with marginal trends toward significance in 2 of 3 indices (P values were 0.121, 0.053, and 0.053 for HOMA2-beta (cp), AUC for C-peptide, and CPI, respectively) (Fig. 3D–F). MPP and PD were quite similar in terms of preservation of beta-cell function (P values were 0.234, 0.610, and 0.126), while unsurprisingly, the most significant difference existed between PD and TP (all 3 P values were 0.030) (Fig. 3D–F).


Small amounts of tissue preserve pancreatic function
Pancreatic endocrine function including OGTT and beta-cell function tests during long-term follow-up studies. (A) OGTT; (B) OGTT insulin release curve; (C) OGTT C-peptide release curve; (D–F) comparison of beta-cell function parameters including HOMA2-Beta (cp), AUC for C-peptide and C-peptide index between patients after TP, MPP, and PD. AUC = area under the curve, HOMA2-beta = modified homeostasis model assessment of beta-cell function, MPP = middle-segment preserving pancreatectomy, OGTT = oral glucose tolerance test, PD = pancreaticoduodenectomy, TP = total pancreatectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120908&req=5

Figure 3: Pancreatic endocrine function including OGTT and beta-cell function tests during long-term follow-up studies. (A) OGTT; (B) OGTT insulin release curve; (C) OGTT C-peptide release curve; (D–F) comparison of beta-cell function parameters including HOMA2-Beta (cp), AUC for C-peptide and C-peptide index between patients after TP, MPP, and PD. AUC = area under the curve, HOMA2-beta = modified homeostasis model assessment of beta-cell function, MPP = middle-segment preserving pancreatectomy, OGTT = oral glucose tolerance test, PD = pancreaticoduodenectomy, TP = total pancreatectomy.
Mentions: In order to further evaluate the endocrine function of preserved pancreatic tissue, we measured serum insulin and C-peptide levels after OGTT (Fig. 3A–C). Insulin levels varied from 0.60 to 16.10 mIU/L for the base value and 4.9 to 35.5 mIU/L for the peak value, while C-peptide ranged from 47.9 to 445 pmol/L and 282 to 2185 pmol/L for base and peak values, respectively. Peak time was 30 to 120 and 60 to 180 min, while the ratio of peak/base value ranged from 1.3 to 57.3 and 2.9 to 10.6 for insulin and C-peptide release, respectively. Cases 1 and 2 showed a peakless release curve at a low level, which was in accordance with their diabetic status. Case 4 showed a delayed peak (peak time 120 min) release curve with a slightly lower peak/base ratio. Cases 3 and 5 had a normal release curve (Table 4; Fig. 3A–C). Beta-cell function was further evaluated with HOMA2-beta (cp), AUC for C-peptide and CPI, and was compared to values measured after TP or PD. Results showed that insulin secretion was at the lowest level after TP, and MPP seemed to have a better endocrine function in comparison to TP with marginal trends toward significance in 2 of 3 indices (P values were 0.121, 0.053, and 0.053 for HOMA2-beta (cp), AUC for C-peptide, and CPI, respectively) (Fig. 3D–F). MPP and PD were quite similar in terms of preservation of beta-cell function (P values were 0.234, 0.610, and 0.126), while unsurprisingly, the most significant difference existed between PD and TP (all 3 P values were 0.030) (Fig. 3D–F).

View Article: PubMed Central - PubMed

ABSTRACT

Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear.

The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP.

From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires.

Our case series included 3 women and 2 men, with median age of 50 (37–81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250–615) min and 800 (400–5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency.

In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.

No MeSH data available.