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Background.
Pancreatogenic diabetes after pancreatectomy is of growing importance due to the increasing life expectancy of pancreatectomized patients. This study aimed to investigate whether perioperative histological degree of islet cells at cut margin are predictive of endocrine pancreatic function after distal pancreatectomy (DP).
Materials and Methods.
This study included consecutive 40 patients who underwent distal pancreatectomy (DP). The percent of islet cells of each pancreas was determined via histological examination of resected specimen at pancreatic cut margin. Pre and postoperative HbA1c levels were measured in blood samples to assess postoperative glucose metabolism insufficiency. For assessing post operative fat absorptive function after DP, non-invasive 13C-mixed triglyceride breath test (13C-MTG-T), labeled long chain triglyceride mixture was performed. Pancreatic exocrine insufficiency, representing fat absorptive disturbance was defined as percent of cumulative 7-hour 13CO2 exhalation (% dose 13C cum 7h) < 5%. Relationship with histological degree of islet cells at cut margin and postoperative HbA1c alteration were analyzed. In this study, diabetic patients were identified as treatment with insulin or oral hypoglycemic medications or HbA1c level ≥ 6.9% (NGSP).
Resuls.
Preoperatively, 14 patients (35%) were diabetes and 26 patients (65%) were non-diabetes. In non-diabetes 26 patients, 12 patients (46%) developed impaired glucose tolerance within one year after DP. 8 patients were administrated oral hypoglycemic medications, one patient needed insulin treatment and other 3 patients were not administrated any medication. Differences in % dose 13C cum 7h were not significantly between patients with DP (9.7±3.2%) and healthy controls (13.3±5.9%). No healthy controls had pancreatic exocrine insufficiency if the diagnosis was based on a %dose 13C cum 7h less than 5 %. In patients after DP operation, only one patient was 5 % %dose 13C cum 7h less than 5 %. In the 26 pre-OP non-DM patients the average percentage of islet cells at cut margin was significantly lower in the post-OP DM group than in the post-OP non-DM group (1.5±0.7% vs 3.5±1.5%, P=0.01). The average area ratio of islet cells at cut margin was correlated with postoperative HbA1c level (P =0.025).
Conclusion.
Differences of fat absorptive function were not significant between patients with DP and healthy controls. Perioperative histological degree of islet cells at cut margin is predictive of glucose metabolism insufficiency after distal pancreatectomy (DP).