THE CORRELATION BETWEEN THE REMNANT PANCREATIC VOLUME AND POSTOPERATIVE ENDCRINE FUNCTION AFTER PANCREATICODUODENECTOMY
tatsuya yamazaki*, Takeshi Aoki, Tomotake Koizumi, Takahito Hirai, Kodai Tomioka, Tomoki Hakozaki, Yusuke Wada, Yoshihiko Tashiro, Koji Nogaki, Kosuke Yamada, Kazuhiro Matsuda, Tomokazu Kusano, Akira Fujimori, Yuta Enami, Masahiko Murakami
Department of Surgery, Division of General and Gastroenterological Surgery, showa university, Yokohama yabe, Kanaagawa, Japan
(Objectives) Diabetes mellitus is the most frequent complications occurring after pancreatectomy; although, only a few reports have evaluated the perioperative changes in pancreatic volume (PV) and the correlation with insulin secretion ability. C-peptide index (CPI) is reportedly a useful parameter to evaluate the endogenous insulin secretion ability. The present study aimed to evaluate the correlation between PV and CPI.
(Methods) From January 2018 to August 2018, 15 patients underwent pancreaticoduodenectomy (PD) in our department, with measurement of PV and CPI before and after the surgery. Dynamic computed tomography (CT) was performed using a 64-Multi-detector row CT scanner, and the axial images were reconstructed at a 0.75-mm section thickness for the measurement of PV. The CT volume data was transferred into workstation (SINAPSE VINCENT; FUJIFILM Medical, Inc., Tokyo, Japan), and the PV was analyzed as the region of interest (ROI). The remnant pancreas volume (RPV) was calculated within 7 days of surgery. The correlation between the change in perioperative PV and CPI were investigated. This study was approved by the institutional review board of the Showa University clinical trial center (No. 2664).
Spearman's rank correlation coefficient was applied to evaluate RPV and insulin secretion correlation. P < 0.05 was considered to be statistically significant. All JMP® 14 (SAS Institute Inc., Cary, NC, USA) was used for the analysis.
(Results) The median age of the subject was 67 years, with a sex ratio of 1:2 male/female, median BMI of 22, and postoperative complications of CD classification I/II/IIIa 1/2/4 cases. The mean preoperative PV（PPV）was 51.8 (12-110) mL, mean RPV was 25 (8.2-67) mL, pancreatic volume reduction rate (the reduced pancreas volume/the volume of the preoperative whole pancreas * 100) was 52% (25.7%-89.6%), mean preoperative CPI was 1.11 (0.05-2.12), and mean postoperative CPI was 0.73 (0.061-1.76). No correlation was noted between PPV and preoperative CPI (ρ = 0.453; p = 0.089), and a positive correlation was noted between RPV and postoperative CPI (ρ = 0.652; p = 0.0084). In multivariate analysis, preoperative CPI and RPV were significantly correlated with postoperative CPI.
(Conclusions) Our results suggest that the ability for endogenous insulin secretion is correlated with the residual pancreatic volume after PD. We believe that this finding will contribute to the management of diabetes mellitus after PD.
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