Changes in glucose metabolism after Kausch-Whipple pancreatectomy in pancreatic cancer and chronic pancreatitis patients.

Objective: Although changes in exocrine pancreatic function after pancreatoduodenectomy (PD) have been thoroughly analyzed in many reports, articles concerning endocrine have been few. An investigation of glucose metabolism changes in patients undergoing PD was performed.

Methods: In the study, 20 patients were subjected to pancreatic head resection for tumorous lesions (13 neoplasmatic and 7 chronic pancreatitis) and followed-up for changes in pancreatic endocrine function. It was assessed with fasting plasma glucose measurement and oral glucose tolerance test and also the plasma insulin level during the oral glucose tolerance test. Assessment was made directly before PD followed 2 and 6 months postoperatively.

Results: The percentage of neoplasmatic patients with normal glucose metabolism increased from 15% preoperatively to 39% at 2 months and 45% at 6 months after PD, whereas the diabetes/impaired glucose metabolism was observed in 31%/54%, 15%/46%, and 18%/36%, respectively. In chronic pancreatitis patients, the percentage of diabetic patients increased from 0% preoperatively to 29% at 2 months and 43% 6 months postoperatively. The average plasma insulin level decreased significantly after PD. Before the PD, the insulin curve suggested the presence of insulin resistance in pancreatic cancer patients, which was not observed after the operation.

Conclusions: Changes in glucose metabolism after PD depend on the etiology of pancreatic tumorous lesion with improvement in neoplasmatic patients and deterioration in chronic pancreatitis patients.