An appraisal of radical pancreatoduodenectomy based on glucagon secretion.

In an attempt to elucidate changes in endocrine functions of the pancreas associated with radical pancreatectomy for periampullary cancer, plasma levels of insulin (IRI) and pancreatic glucagon (IRG) were measured during arginine infusion in ten patients with periampullary cancer both before and after pancreatoduodenectomy. The response of plasma IRI to arginine which was impaired before the surgery showed further impairment after the surgery. This finding is consistent with the previous results obtained in such patients by oral glucose tolerance testing. Also, the response of plasma IRG was subnormal preoperatively and was found to be impaired postoperatively. Both maximum and integrated secretion of IRG during arginine infusion decreased after the surgery in all instances. From these findings, it is concluded that pancreatoduodenectomy aggravates the already disordered pancreatic endocrine functions, as indicated by arginine infusion in patients with periampullary cancer.