Pancreatectomy Linked to Endocrine Function Impairment and Diabetes in Women

New research into distal pancreatectomies indicates that women and overweight patients have an elevated risk of suffering endocrine function impairment that leads to glucose intolerance and diabetes mellitus.

Korean researchers recruited 101 patients who had normal endocrine function and no diabetes before they underwent distal pancreatectomy. The study team then measured oral glucose tolerance, HbA1c levels and pancreatic volume 1 week and 1 year after each patient’s surgery.

Mean patient age was 54.1 years at baseline, while mean body mass index (BMI) was 23.3 kg/m² and the sex ratio was almost 2-to-1 female. Resected pancreas volume ranged widely, from just 5.0% to 71.3%, with a median of 28.0%.

At the 1-year mark, 51 patients (50.5%) had developed some form of glucose intolerance. Tests found impaired fasting glucose in 26 of those patients and full-blown cases of diabetes in the other 25. Receiver operating characteristic (ROC) curve analysis showed that a resected pancreas volume of 25% or more showed the maximum diagnostic value in predicting which patients would develop glucose intolerance.

“Univariate analysis showed that female sex (58.5 vs. 36.1 %, P = 0.031), BMI (24.1 vs. 22.5 kg/m², P = 0.010), larger resected volume (36.5 vs. 28.0 %, P = 0.026), and lower remnant volume relative to BMI (1.7 × 10⁻³ vs. 2.1 × 10⁻³ m⁵/kg, P = 0.021) were risk factors for postoperative endocrine function impairment,” the study authors wrote in World Journal of Surgery.

Multivariate analysis found that female sex was an independent predictor of endocrine impairment (odds ratio [OR], 5.818; p=0.003), as were higher BMI (OR, 10.556, p=0.006) and resected pancreatic volume greater than 25% (OR, 3.192; p=0.035). Indeed, the odds ratios were high enough and the p values small enough in all 3 categories that the study authors believe their findings indicate “the need for preoperative evaluation and careful perioperative glucose monitoring in these patients.”

Distal pancreatectomy is a procedure that removes the bottom section of a patient’s pancreas. Such procedures are performed for a wide range of reasons, but the most common of them is to remove a tumor in the body or the tail of the pancreas.

The Korean study did not report on patient exocrine function, but prior research has typically found that only a small percentage of patients suffer serious digestive problems after distal pancreatectomy — unless they were suffering digestive problems before the surgery.

A paper that appeared in the Annals of Surgery, for example, followed 90 patients who underwent the procedure to treat pancreatitis. Its authors reported that little effect was seen on exocrine function. “Preoperative exocrine function was abnormal in two thirds of those tested and was unchanged at follow-up,” they wrote.

That said, the more of the pancreas the surgeons remove, the greater the risk that surgery will impair exocrine function.

“The postoperative exocrine pancreatic function after pylorus-preserving pancreatoduodenectomy and distal pancreatectomy was significantly influenced by the morphology of the pancreas at the presumed transection line,” wrote the authors of a Japanese study that appeared in The American Journal of Surgery. “It is important to evaluate the preoperative morphology of the presumably remaining pancreas, especially duct-parenchymal ratio, to predict the exocrine pancreatic function short term after pancreatectomy.”