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PubMed1987

Total pancreatectomy for chronic pancreatitis.

A survey of six British centres collected data on 83 patients undergoing total pancreatectomy (TP) for chronic pancreatitis between 1977 and 1986. There were 57 men and 26 women with a median age of 38 years (range 19-61 years). Half were alcoholics and half had had previous acute pancreatitis. Besides jaundice (14 per cent) severe pain was the indication for the operation; regular opiates had been needed in 82 per cent of patients and 37 per cent were addicted to these drugs. All but 12 had had previous pancreatic or biliary surgery, with a median of two operations and a maximum of six. TP was a one-stage procedure in 32 patients, 42 had had distal resections and 9 proximal resections in the past; the pylorus was preserved in 30. Median operation time was 4 h (range 2-18 h) and median blood loss was 3 units (1-21 units). Intraoperative complications in 11 patients included haemorrhage in 9. Four deaths occurred within 30 days from bleeding (2), respiratory failure (1) and Roux-loop infarction (1). All but one of the 79 survivors required full pancreatic supplementation and 38 per cent had difficulties in endocrine control. At a median follow-up of 1.5 years (range 0.25-10 years), 57 patients (72 per cent) were pain-free and 9 (11 per cent) needed only occasional analgesia. Though 13 (17 per cent) still took regular analgesics, all were symptomatically improved. There have been 10 late deaths (13 per cent), all but one of which are attributable to the operation.

Adult↗

PubMed1989

Pylorus-preserving pancreatectomy: functional results.

The pylorus-preserving technique is reported as improving the functional results of pancreatectomy but it is complicated in the early postoperative period by delayed recovery of gastric function in a proportion of patients. We have examined early and late gastrointestinal function in a prospective study of 16 patients having this procedure. The late results appear better than reported results for conventional Whipple resection and the delay in early recovery does not appear to have any late sequelae, provided that it does not require gastric bypass for relief.

Adult↗

PubMed1993

Improved glucose metabolism after subtotal pancreatectomy for pancreatic cancer.

Diabetes occurs frequently in patients with pancreatic cancer. To investigate the impact to tumour removal, seven patients were studied before and after 85 per cent subtotal pancreatectomy for adenocarcinoma of the pancreas. The frequency of diabetes was determined by the oral glucose tolerance test. Fasting levels of C peptide and insulin were measured in plasma, and insulin secretion was investigated by hyperglycaemic glucose clamp and glucagon stimulation. Six of the seven patients were diabetic before surgery and four required insulin treatment. Improvements in diabetic status and glucose metabolism were found in all seven patients after operation, as demonstrated by increased glucose metabolic capacity during hyperglycaemia. This occurred despite a postoperative reduction in insulin secretion and is explained by the observed augmentation of whole-body insulin sensitivity after surgery. A diabetogenic factor may be produced by pancreatic adenocarcinoma that may be responsible, directly or indirectly, for the high frequency of diabetes in patients with pancreatic cancer.

Adenocarcinoma↗

PubMed2005

Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy.

BACKGROUND: Appropriate closure of the pancreatic remnant after distal pancreatectomy is still debated. A variety of procedures have been recommended to reduce the frequency of pancreatic fistula. This review quantitatively compares the available techniques. METHODS: Original articles and abstracts published up to the end of June 2004 were searched without language restriction in the Cochrane Controlled Trials Register, Medline and Embase. Three reviewers independently assessed each study's eligibility and quality, and extracted the data. A random effects model was performed using weighted odds ratios. RESULTS: Only ten of 262 articles could be included, two randomized clinical trials and eight observational studies. Reported postoperative morbidity varied from 13.3 to 64 per cent. The primary outcome measure, pancreatic fistula rate, occurred within the range 0-60.9 per cent. Meta-analysis of the six studies comparing stapler versus hand-sutured closure showed a non-significant combined odds ratio for occurrence of a pancreatic fistula of 0.66 (95 per cent confidence interval 0.35 to 1.26, P = 0.21) in favour of stapler closure. CONCLUSIONS: The quality and quantity of information extracted from the available trials are insufficient to enable any firm conclusion to be drawn on the optimal surgical technique of pancreatic stump closure; there is a trend in favour of the stapling technique.

Epidemiologic Methods↗

PubMed1996

Effect of octreotide on pancreatic endocrine function in partial pancreatectomy.

Octreotide acetate (Sandostatin), a long-acting somatostatin analogue, has been demonstrated to inhibit pancreatic exocrine secretion. The effect of octreotide acetate on pancreatic endocrine function in patients undergoing pancreas surgery or pancreas transplantation has not been as well described, nor have the clinical implications been studied as systematically. This study was designed to investigate the effects of octreotide acetate on glucose metabolism and endocrine function in a partial pancreatectomized canine model, simulating reduced islet cell reserve. Serum levels of glucose, insulin, and glucagon were determined at intervals over 2 hr following an intravenous glucose tolerance test (0.5 g/kg intravenous bolus of 50% glucose) in: normal animals (Group A, n = 5), normal animals pretreated with an intravenous bolus of 400 micrograms of octreotide acetate (Group B, n = 5), partial pancreatectomized animals (Group C, n = 5), and partial pancreatectomized animals pretreated with an intravenous bolus of 400 micrograms of octreotide acetate (Group D, n = 5). Peak glucose concentration was significantly increased in Group D when compared to Group C (Group C = 304.2 +/- 13.5 mg/dl vs Group D = 353.2 +/- 12.9 mg/dl, P < 0.05), indicating an impairment of glucose metabolism by octreotide. In addition, octreotide significantly decreased peak insulin release in the partial pancreatectomy groups (Group C = 129 +/- 12.9 micro U/ml vs Group D = 47.5 +/- 6.8 micro U/ml, P < 0.05). There were no significant differences in the rate of glucose utilization or glucagon concentrations among the groups. These results demonstrate that octreotide does result in insulin suppression, with a resultant increase in stimulated glucose concentrations, in a canine model of reduced islet cell mass. Further studies are required to determine the mechanism of action of octreotide on endocrine function in the setting of pancreas transplant.

Animals↗

PubMed1996

Effect of subtotal pancreatectomy on the rate of liver regeneration: the role of hepatic stimulator substance.

The endogenous signals controlling liver regeneration are becoming rapidly defined. One of the key findings during liver regeneration following partial hepatectomy is the appearance of peripheral blood factors that stimulate DNA synthesis in the parenchymal cells. Hepatopoietin A, or hepatocyte growth factor, has been described as a complete mitogen for hepatocytes, one of its major tissue sources being the pancreas. The changes in the rate of DNA synthesis (incorporation of [3H] thymidine into DNA) in both subtotally pancreatectomized-partially hepatectomized (Group A) and partially hepatectomized (Group B) male rats were determined at different postoperation times. DNA synthesis in Group A was increased progressively, reaching a maximum at 40 hr after operation in contrast to the 24- and 32-hr peaks obtained in nonpancreatectomized rats (Group B). However, liver regeneration in Group A was significantly lower than in Group B. To evaluate the effects of hepatic stimulator substance (HSS) on liver regeneration, the time course of HSS biological activity during the liver regeneration process was determined in the livers of Group A rats. A concurrent change of HSS activity and rate of liver regeneration was observed. These results support the hypothesis that HSS biological activity may be delayed but not suppressed by subtotal pancreatectomy.

Alanine Transaminase↗

PubMed1997

Effects of partial pancreatectomy on liver regeneration in rats.

Pancreatoduodenectomy with major hepatectomy has recently been employed for patients with advanced biliary malignancies as potential curative surgery. However, postoperative liver decompensation is a major unfavorable complication with this procedure; the main cause of the sequelae is disturbance growth. In our present study, hepatic regeneration and nutritional status following simultaneous resection of the liver and the pancreas were evaluated in an experimental animal model. Eighty SD rats were divided into four groups: control group (sham laparotomy, n = 20), 50% partial pancreatectomy group (Px, n = 20), 68% hepatectomy group (Hx, n = 20), and Px plus Hx group (n = 20). Five rats in each group were sacrificed for blood and liver collection on the first, second, third, and seventh postoperative days, respectively. One hour before sacrifice, 5-bromo-2-deoxyuridine (20 mg/kg/body weight) was injected intraperitoneally and BrdU-labeled nuclei in the liver were demonstrated immunohistochemically to allow examination of the mitotic response. Body weight increase rate (BWR), the liver wet weight (LWW), the ratio of the LWW to body weight, and the liver regeneration rate were calculated. Serum activity of alanine aminotransferase and levels of serum bilirubin and albumen were also measured. The LWW was relatively decreased after simple Px with no change in the BrdU labeling index or mitotic index. The highest peak of DNA synthesis of hepatocytes in the remaining lobes was markedly reduced on the first day after Hx + Px, with a delay in the hepatic regeneration response extending to the seventh postoperative day. Decrease in BWR in both the Px group and the Hx + Px group was observed on the first 3 postoperative days, with gain of BWR in the former case being slower. Removal of a portion of the pancreas can decrease hepatic weight under both normal and regenerative conditions. Simultaneous major resection of the liver and a portion of pancreas results in reduction and delay in the highest peak of DNA synthesis of hepatocytes in the remnant liver. We speculate that the pancreatic exocrine glands may play a distinct role in supporting the liver and in triggering hepatocyte proliferation.

Alanine Transaminase↗

PubMed1993

Heterotopic autotransplantation of the pancreas segment after pylorus-preserving total pancreatectomy: a case report of successful surgical treatment for chronic pancreatitis.

A 38-year-old man who had suffered for 5 years from persistent abdominal pain caused by alcoholic chronic pancreatitis, presented with diffuse calcification of the entire pancreas with cystic formation of the pancreatic head. After a pylorus-preserving total pancreatectomy, the pancreatic head, including the cyst, was removed extracorporeally by bench surgery, and the remaining segment of the body and tail autotransplanted heterotopically to the iliac vessels with a pancreaticojejunostomy. Total resolution of the pain was achieved postoperatively, and dietary intake has been satisfactory. Both endocrine and exocrine pancreatic functions have been well preserved, and no insulin has been needed. Three months after his operation, the patient has returned to leading a normal life.

Adult↗

PubMed1979

[Is total pancreatectomy still responsible treatment for chronic pancreatitis? (author's transl)].

A total of 61 pancreatectomies for chronic pancreatitis are reported. The operative mortality rate was 21% and the later mortality rate 29%, although caused by diabetes. The results are so poor that this method should only be performed in extreme situations. Left or right resection of the main inflammation site is proposed as an alternative. To prevent recurrence of the pancreatitis, the in situ remaining part of the pancreas should be sclerosed by occlusion of the pancreatic duct system.

Adult↗

PubMed1976

Total pancreatectomy in the treatment of acute necrotising and hemorrhagic pancreatitis. Indications-technique.

The place of total pancreatectomy in the treatment of pancreatitis is still not clear: the author is in favour of this operation and gives the indications, surgical technique, complications and results. The operation is indicated in cases of necrosis involving more than 2/3rds of the whole of the head and part of the body of the pancreas. The duodenum and pancreas should be removed in one piece and intestinal continuity should be restored performing choledocho-jejunal and gastro-jejunal anastomoses. It is important to carry out this operation early, between the 3rd and 6th days, treating all areas of necrosis before the lesions become the site of uncontrollable infection. Seven patients out of 9 are still alive, on the 25th of July 1975; they all have easily controlled diabetes, a low fat diet and are receiving pancreatic extract. We have recently operated a 10th case, and the patient is alive 2 months later.

Acute Disease↗

PubMed1989

Combined subtotal pancreatectomy with selective streptozotocin infusion--a model for the induction of insulin deficiency in dogs.

Standardized models of type I diabetes-like insulin deficiency in larger laboratory animals hardly exist. It was therefore investigated whether stable long-term insulin deficiency in dogs can be induced by selective beta-cell destruction in a safe and reliable procedure without damage of other organs. In Beagle dogs, the diabetogenic response to systemic streptozotocin administration (38.5-28 mg/kg b.wt.) was tested. In addition, resection of corpus and cauda pancreatis in combination with selective streptozotocin perfusion (25 mg/kg b.wt.) of the remaining pancreas tissue was evaluated. Whereas systemic streptozotocin administration failed to destroy insulin secretion, but led to a variety of intoxication symptoms even in comparatively low doses (28 mg/kg b.wt.), the latter procedure resulted in a complete and persistent insulin depletion (basal serum immunoreactive insulin less than or equal to 3 microU/ml, no stimulated response) without toxic organ damage or other serious side effects. The dogs developed type I-like diabetes, which required continuous exogenous insulin substitution. From these results, subtotal pancreatectomy with selective streptozotocin perfusion of the remaining pancreas is proposed as a safe model of insulin deficiency in dogs, which should be further evaluated in experimental diabetology.

Animals↗

PubMed1991

Partial pancreatectomy in rats causes an impairment of the glucose-induced stimulation of pancreatic islet blood flow.

Adult rats were subjected to either a sham operation (S-rats) or a 60% partial pancreatectomy (P-rats). Both P- and S-rats were normoglycemic and normoinsulinemic after surgery. Four weeks later, the animals were injected i.v. with 1 ml of either 0.9% (w/v) saline or 30% (w/v) D-glucose, and after 5 min whole pancreatic blood flow (PBF) and islet blood flow (IBF) were measured, using a microsphere technique. In the saline-injected P-rats both PBF and IBF values were higher than in S-rats (p less than 0.001 for both values). Administration of glucose had no effects on PBF in either S- or P-rats when compared to saline-injected animals. IBF was, however, markedly increased (p less than 0.01) by glucose in S-rats in comparison with saline-injected S-rats, whilst no difference in IBF was observed between glucose- and saline-injected P-rats. The fraction of PBF diverted through the islets (fIBF) was approximately 10% in S-rats and 20% in P-rats. Glucose increased fIBF in S-rats, but had no effect in P-rats. In conclusion, in S-rats a glucose-stimulated insulin release is accompanied by an increase in IBF, but this is not observed in P-rats.

Animals↗

PubMed1983

Effects of total pancreatectomy on the secretion of gut glucagon in humans.

To determine how total pancreatectomy influences the secretion of gut glucagon in man, 15 totally pancreatectomized patients (Px), 14 distally gastrectomized patients (Gx), and 15 healthy subjects were investigated by intravenous arginine infusion test and oral glucose tolerance test. Blood glucose, plasma insulin (IRI), and C-peptide (CPR) levels were determined. Plasma immunoreactive glucagon (IRG) and total glucagon-like immunoreactivity (total GLI) were also measured. Gut glucagon-like immunoreactivity (gut GLI) was calculated to be the difference between total GLI and IRG. In the Px group, arginine infusion did not significantly alter the levels of IRI, CPR, IRG, and gut GLI. Mean basal value of gut GLI in the Px group of 356 +/- 40 pg/ml was significantly higher than 179 +/- 26 pg/ml of the healthy (p less than 0.01) and 182 +/- 24 pg/ml of Gx group (p less than 0.01). Oral glucose loading led to the highest increase of gut GLI in the Px group (p less than 0.01). Thus, extrapancreatic IRG may not be secreted into the plasma in totally pancreatectomized humans in response to arginine stimulation. Complete absence of the pancreas and the deficiency of insulin-effect may lead to a hypersecretion of gut GLI, both in the basal state and after oral glucose loading.

Adult↗

PubMed1986

Paradoxical elevations of plasma glucagon levels in patients after pancreatectomy or gastrectomy.

In twenty-five patients undergoing total pancreatectomy (TP), twenty distal gastrectomy (DG) and twenty healthy subjects, effects of oral glucose loading on the plasma glucagon (IRG) levels were determined. Plasma IRG levels were elevated after glucose loading in the TP and DG patients, but not in the healthy subjects. To clarify events related to the elevations in IRG, the plasma IRG components were analyzed by gel filtration in 6 of the TP patients, 5 of the DG patients and 4 of the controls. In the TP group, IRG3500 was not detectable either in the basal state or after glucose loading, while IRG9000 was markedly increased after glucose (p less than 0.002). In the DG group, IRG3500 was significantly suppressed after glucose (p less than 0.05), but IRG9000 was clearly increased (p less than 0.005). In the controls, IRG3500 was suppressed after glucose (p less than 0.05), however, IRG9000 was not detected throughout the examination. Thus, in patients with TP or DG, the essential cause of the high responses of plasma glucagon after oral glucose loading was the increase in IRG9000. Because the food passage route is much the same in TP and DG patients, the IRG9000 elevations are probably related to secretion in the digestive tract.

Adult↗

PubMedDate not supplied

The long-term effects of pancreatectomy on the Ca metabolism of the rat.

The Ca metabolism of pancreatectomized (PX) rats was investigated three months after surgery. Most PX animals were in negative Ca balance because of increased endogenous fecal Ca excretion and reduced true Ca absorption. Significant increases were also observed in bone Ca resorption rates, hydroxyproline excretion and size of osteocyte lacunae. Inverse correlations between the rates of bone Ca resorption and Ca balance were observed in the PX and control groups. Significantly, both correlations were found to fit the same function. It was concluded that parathyroid hormone secretion and its metabolic expression were not impaired by pancreatectomy. The coupling between bone Ca accretion and resorption was absent in PX animals: high resorption rates were found associated with normal or decreased accretion rates. These latter rates, in combination with the negative Ca balance, explain the reduction in the skeletal Ca mass.

Animals↗

PubMed1980

Changes in plasma glucagon after total pancreatectomy in man.

Changes in the blood glucagon reactive to 30K antibody were followed in two patients before, during, and after total pancreatectomy. The blood glucagon level was decreased six hours after the operation, and then increased gradually unless insulin was administered. The increased non-pancreas glucagon was immediately suppressed by insulin administration. The glucagon secretion response to an arginine load was already low one week after the operation, and was absent even three weeks after the operation.

Adenocarcinoma, Papillary↗

PubMed1993

Heterotopic autotransplantation of a pancreas segment with enteric drainage after total or subtotal pancreatectomy for chronic pancreatitis.

Four patients with chronic alcoholic pancreatitis and one patient with idiopathic chronic pancreatitis, who had total or subtotal distal pancreatectomies for persistent pain, underwent simultaneous autotransplantation of a pancreas segment to preserve the pancreatic function. The segment was autotransplanted heterotopically to the iliac fossa with anastomosis of the splenic vessels to the iliac vessels to prevent reinnervation, and the pancreatic duct was anastomosed to the intestine to preserve exocrine function. Postoperatively, the patency of the graft vessels was confirmed by angiography in every patient. Complete pain relief has been obtained in all patients with a followup duration of 4-89 mo. Except for one patient who had been treated preoperatively with insulin injections for diabetes, the patients remained normoglycemic without exogenous insulin administration and demonstrated satisfactory insulin secretion during a 75-g oral glucose tolerance test. An exocrine pancreatic diagnostant test using p-aminobenzoic acid yielded nearly similar levels to the preoperative value for all patients. Heterotopic autotransplantation of the pancreas segment appears to be effective for preserving pancreatic function, as well as providing permanent pain relief for patients with chronic pancreatitis who require extensive resection of the pancreas.

Adult↗

PubMed1997

Distal pancreatectomy with en bloc resection of the celiac artery for carcinoma of the body and tail of the pancreas.

CONCLUSION: Combined resection of the celiac artery with a distal pancreatectomy (DP) increases the resectability and improves the overall prognosis of patients with locally advanced ductal cancer of the body and tail of the pancreas. BACKGROUND: Carcinoma of the body and tail of the pancreas is often unresectable because of invasion to adjacent organs. We evaluated a DP including an en bloc resection of the celiac artery ("extended"), for pancreatic cancer that had invaded the common hepatic and/or celiac arteries. METHODS: Six cases of an "extended" DP were compared with 19 cases of a "standard" DP for pancreatic ductal carcinoma in terms of clinical and pathologic findings, perioperative course, and long-term outcome. We also compared the survival rate of these two groups with a third group consisting of 22 patients with unresectable pancreatic ductal carcinoma. RESULTS: The mean operative time, postoperative serum aspartate aminotransferase concentration, and length of hospital stay did not significantly differ between the "extended" and "standard" DP groups. The cumulative 1- and 3-yr accumulated survival rates for the "extended," "standard," and unresectable groups were 40.0, 33.3, and 5.4, and 20.0, 16.6, and 0%, respectively. Statistically significant differences (p < 0.01) existed between the "extended" and unresected groups.

Adult↗