POST-PANCREATECTOMY VOLUMETRIC ANALYSIS: A MISSING VARIABLE IN THE DEVELOPMENT OF POST-OPERATIVE ENDOCRINE AND EXOCRINE DYSFUNCTION
Michael E. Johnston*, Shaun A. Wahab, Kevin Turner, Dennis J. Hanseman, Syed Ahmad, Sameer Patel, Gregory C. Wilson
Surgery, University of Cincinnati, Cincinnati, OH
Introduction: Postoperative pancreatic endocrine (PEnDef) and exocrine deficiency (PExDef) are a source of long-term morbidity after pancreatic resection. Most previous reports have focused on patient characteristics without including volumetric analysis. The aim of this current study is to evaluate factors associated with postoperative PEnDef and PExDef including volumetric analysis.
Methods: Consecutive patients undergoing formal pancreatic resection between 2017-18 at a single institution were examined. Patients with a minimum of 1 year follow up with complete postoperative outcomes and imaging were included. Diabetes was diagnosed according to established ADA definitions. PExDef was determined by requiring pancreatic enzyme replacement at 1-year post op. Pre- and post-operative pancreatic volumes were calculated by a single blinded radiologist with expertise in pancreatic imaging using GE AW Server 3.2 volumetric software.
Results: Sixty-eight patients underwent pancreatectomy that met inclusion criteria. 47% (n=32) of patients were female, median BMI was 27.45 kg/m2 ('±5.74), 57% (n=39) were diagnosed with pancreatic adenocarcinoma, and 66% (n=45) underwent pancreaticoduodenectomy while the remainder (34%, n=23) underwent distal pancreatectomy.
The overall incidence of PEnDef was 32.5% (n=13) and PExDef was 50% (n=27). The incidence of PEnDef was higher after distal (57% vs. 16%, p 0.01) and the incidence of PExDef was higher after Whipple (66% vs 21%, p 0.004). Mean preoperative pancreas volume was 76.2 mm3 '±51.22 for all patients. the mean post pancreatectomy remnant volume after Whipple was 23.1 '±21.4 mm3 (range = 5 -65 mm3) with 67.3% volume resected, while after distal pancreatectomy the mean post pancreatectomy remnant volume was 44.8 mm3 +/- 19.5 (range = 17 to 70 mm3) with mean of 37.7% resected.
Logistic regression analysis was performed for predictors of PEnDef and PExDef as listed in Table 1. The only factors associated with PEnDef on multivariate analysis were presence of hyperlipidemia (OR=76, 95%CI 3.39-999, p value 0.01) and undergoing distal pancreatectomy (OR=30.3, 95%CI 1.58-581, p value 0.02). On multivariate analysis the only factor associated with PExDef was postoperative remnant pancreas volume (OR=0.93, 95%CI 0.88-0.98. p value <0.01).
Conclusion: Postoperative pancreas remnant volume was the only factor associated with the development of exocrine insufficiency after pancreas resection. While patient factors such as hyperlipidemia and type of resection were associated with PEnDef. These models can be used to counsel patients on risk of post-pancreatectomy endocrine and exocrine deficiency before surgery.
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