Volume and functional changes of remnant pancreatic tissue after pancreatectomy: Does pancreas regenerate?

  • 呂 維勛

Student thesis: Doctoral Thesis

Abstract

Pancreatectomy is a standard treatment for several indications such as pancreatic adenocarcinoma pancreatic adenoma pancreatic cysts and chronic calcified pancreatitis There are two major surgical methods of pancreatectomy including pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) depending on the location and extent of pancreatic lesion Pancreatectomy is much safer nowadays the mortality rate of PD has decreased to 0% ~ 5% in large-scale medical centers The improvement of survival rate after pancreatectomy had promoted the consideration of long-term metabolic consequences Unlike the well-documented liver regeneration after partial hepatectomy pancreatic regeneration after pancreatectomy is still controversial Herein the aims of this study are to determine the changes of volume in the remnant pancreas and to define whether above volume changes of pancreas correlate with the function of glucose metabolism This study included the patients from Jan 2009 to Dec 2017 undergoing partial pancreatectomy including PD and DP for a variety of disease During follow-up the endocrine functions were assessed according to the level of glucose HbA1C C-peptide in serum The volume of pancreas was determined via abdominal computed tomography (CT) scan before the operation and at 3months 1 year and 2 years postoperatively In all enrolled 135 patients 90 patients underwent PD and 45 patients underwent DP Our results showed that the remnant pancreas in the PD group had an atrophic change The mean ratio of the remnant pancreas compared with initial residual pancreas at 3 months 1 and 2 years after pancreatectomy were 80 79% 68 67% and 65 34% respectively (p < 0 001) In contrast the remnant pancreas in most of the DP patients are slightly hypertrophic the mean ratio of the remnant pancreas at 3 months 1 and 2 years postoperatively were 106 25% 106 62% and 110 43% (p = 0 019) Although the DP patients had higher incidence of new-onset diabetes than the PD patients but the difference was not statistically significant (33 3% vs 22 7% p = 0 115) In addition 29 2% of the PD patients with preoperative diabetes mellitus (DM) had resolved after PD However neither the pancreas’ volume nor C-peptide level showed significant correlation with postoperative new-onset DM Our results also cannot found the relationship between C-peptide level and remnant pancreas’ volume The C-peptide level dropped significantly after partial pancreatectomy in both groups (p < 0 001) and this phenomenon was more severe in the DP group Postoperative C-peptide levels were restored partially in both groups (β ± SE= 16 33 ± 5 03 p = 0 001) regardless of the volume change Compared to DP group PD group had greater restoration capacity of C-peptide secretion (β ± SE = 13 26 ± 5 50 p = 0 016) In conclusions the remnant pancreas tissue atrophied in the PD patients but hypertrophied in DP patients The function of β-Cell would be partially restored after partial pancreatectomy in both groups and the distal portion of remnant pancreas in the PD group had greater restoration capacity of β-Cell
Date of Award2019
Original languageEnglish
SupervisorYan-Shen Shan (Supervisor)

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