American journal of surgery · 2025
Analysis of CT-based pancreatic volumetrics and postoperative endocrine and exocrine dysfunction: A retrospective cohort study.
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Hariri Hussein M, Wahab Shaun A, Johnston Michael E, Surapaneni Sweya, Pratt Catherine G, Szu-Aun Long, Hanseman Dennis J, Ahmad Syed A, Patel Sameer H, Wilson Gregory C
Аннотация
BACKGROUND: In this current study factors associated with postoperative pancreatic endocrine (PEnDef) and exocrine deficiency (PExDef) after pancreatic resection including volumetric analysis were studied.
METHODS: Consecutive patients undergoing pancreatic resection between 2017 and 2018 with at least one year of follow up were included. Diabetes was diagnosed per established ADA criteria. PExDef was defined as pancreatic enzyme replacement requirement at 1-year. Pre- and post-operative pancreatic volumes were calculated by a single-blinded abdominal radiologist with expertise in pancreatic imaging.
RESULTS: The overall incidence of PEnDef was 29.5 % and PExDef was 50 %. PEnDef was more common following distal pancreatectomy (57 % vs 17 %, p = 0.01) and PExDef was more common following pancreatoduodenectomy (66 % vs 21 %, p = 0.004). Median pancreatic remnant volume after pancreatoduodenectomy was 23.11 [11.50-32.44] cm3 and distal pancreatectomy was 44.81 [34.42-53.10] cm3. Multivariable analysis showed hyperlipidemia (OR = 76, 95 %CI 3.39-999, p = 0.01) and distal pancreatectomy (OR = 30.3, 95 %CI 1.58-581, p = 0.02) were associated with PEnDef. The only independent predictor of PExDef was postoperative remnant pancreas volume (OR = 0.93, 95 %CI 0.88-0.98, p < 0.01).
DISCUSSION: Postoperative remnant pancreas volume is associated with PExDef, whereas hyperlipidemia and type of pancreatic resection are associated with PEnDef. These models can be used to counsel patients on risks after pancreatectomy.
METHODS: Consecutive patients undergoing pancreatic resection between 2017 and 2018 with at least one year of follow up were included. Diabetes was diagnosed per established ADA criteria. PExDef was defined as pancreatic enzyme replacement requirement at 1-year. Pre- and post-operative pancreatic volumes were calculated by a single-blinded abdominal radiologist with expertise in pancreatic imaging.
RESULTS: The overall incidence of PEnDef was 29.5 % and PExDef was 50 %. PEnDef was more common following distal pancreatectomy (57 % vs 17 %, p = 0.01) and PExDef was more common following pancreatoduodenectomy (66 % vs 21 %, p = 0.004). Median pancreatic remnant volume after pancreatoduodenectomy was 23.11 [11.50-32.44] cm3 and distal pancreatectomy was 44.81 [34.42-53.10] cm3. Multivariable analysis showed hyperlipidemia (OR = 76, 95 %CI 3.39-999, p = 0.01) and distal pancreatectomy (OR = 30.3, 95 %CI 1.58-581, p = 0.02) were associated with PEnDef. The only independent predictor of PExDef was postoperative remnant pancreas volume (OR = 0.93, 95 %CI 0.88-0.98, p < 0.01).
DISCUSSION: Postoperative remnant pancreas volume is associated with PExDef, whereas hyperlipidemia and type of pancreatic resection are associated with PEnDef. These models can be used to counsel patients on risks after pancreatectomy.