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Background: Pancreatic insufficiency (PI), in the form of endocrine or exocrine insufficiency, is a well-known complication following pancreatic surgery. Despite this, the exact incidence is not known and reported rates are widely disparate.
Hypothesis/Objectives: To determine and compare rates of endocrine and exocrine insufficiency following pancreaticoduodenectomy (PD) and left pancreatectomy (LP).
Design: Retrospective cohort
Setting: Single institution, tertiary care center
Patients and Methods: Data from 129 consecutive patients who underwent PD and LP over a six year period (1/2006-12/2011) were retrospectively reviewed. Exocrine insufficiency was defined as need for pancreatic enzymes (PE) following resection. Endocrine insufficiency was defined as new onset or worsening diabetes mellitus (DM).
Results: There were 129 patients that underwent pancreatic resection: 68 PD, 61 LP. New onset exocrine insufficiency for the entire cohort was 28% (32 of 129 patients). Exocrine insufficiency was significantly higher in the PD cohort versus LP (42.6% (n=29) vs. 4.9% (n=3), p<0.001). A significant portion of the population had endocrine insufficiency preoperatively (32.6%, n=42). New onset or worsening DM was diagnosed in 16.2% (n=11) of PD patients compared to 24.6% (n=15) of LP patients but this was not statistically significant (p=0.16). New onset PI in any form occurred in 40.3% of patients (52 out of 129). This was statistically higher in PD patients at 50% (n=34) vs 29.5% (n=18) for LP, (p=0.02).
Conclusion: Pancreatic insufficiency occurs frequently after pancreatic resection and patients should be counseled accordingly preoperatively. Clinicians should have a low threshold to diagnose and treat exocrine and endocrine insufficiency in the postoperative pancreatic resection patient.