Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection
Department of Surgery, Division of Surgical Oncology; Department of Medicine, Division of Gastroenterology
Digestive System Diseases | Gastroenterology | Hepatology | Surgery
BACKGROUND: Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy.
METHODS: Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227). Subjects who underwent total pancreatectomy or pancreatitis surgery were excluded. New post-operative endocrine and exocrine insufficiency was defined as the need for new pharmacologic intervention within 1000 days from resection.
RESULTS: 28 (16%) of 178 subjects without pre-existing endocrine insufficiency developed post-operative endocrine insufficiency: 7 (25%) did so within 30 days, 8 (29%) between 30 and 90 days, and 13 (46%) after 90 days. 94 (43%) of 214 subjects without pre-operative exocrine insufficiency developed exocrine insufficiency: 20 (21%) did so within 30 days, 29 (31%) between 30 and 90 days, and 45 (48%) after 90 days. Adjuvant radiation was associated with new endocrine insufficiency. On multivariate regression, pancreaticoduodenectomy and chemotherapy were associated with a greater risk of exocrine insufficiency.
CONCLUSION: Reporting 30-day functional outcomes for pancreatic resection is insufficient, as nearly 45% of subjects who develop disease do so after 90 days. Reporting of at least 90-day outcomes may more reliably assess risk for post-operative endocrine and exocrine insufficiency.
DOI of Published Version
HPB (Oxford). 2016 Apr;18(4):360-6. doi: 10.1016/j.hpb.2015.11.003. Epub 2016 Feb 17. Link to article on publisher's site
HPB : the official journal of the International Hepato Pancreato Biliary Association
Lim P, Dinh KH, Sullivan ME, Wassef WY, Zivny J, Whalen GF, LaFemina J. (2016). Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection. Open Access Publications by UMMS Authors. https://doi.org/10.1016/j.hpb.2015.11.003. Retrieved from https://escholarship.umassmed.edu/oapubs/2870