Background

Exocrine pancreatic insufficiency (EPI) is a known consequence of pancreatic resection; however, its incidence following distal pancreatectomy is not well defined. The aim of this study was to describe the prevalence of EPI in patients undergoing distal pancreatectomy and moreover identify risk factors for developing de-novo EPI after distal pancreatectomy.

Methods

A prospectively maintained institutional pancreatic resection database was interrogated to identify patients who underwent distal pancreatectomy from 2005 to 2015. Pre- and post-operative exocrine function, histopathology, demographics and volume of pancreas resected were analyzed.

Results

The cohort consisted of 324 patients, 22 (6.8%) presented with EPI pre-operatively. 38 (12.6%) patients developed new onset EPI requiring pancreatic enzyme replacement therapy. There was no relationship between patient demographics or diabetes status and requirement for pancreatic enzyme replacement therapy, and no significant effect of resection volume on the need for pancreatic enzyme replacement therapy post-operatively (p ≥ 0.05). Having an underlying obstructive pancreatic pathology (p = 0.002) or a presenting history of acute pancreatitis (p < 0.001) significantly predicted development of de-novo EPI.

Conclusion

These results indicate that pre-existing EPI at time of surgery is not uncommon. Patients presenting for distal pancreatectomy should be assessed pre-operatively for the need for pancreatic enzyme replacement therapy.

中文翻译：

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胰腺远端切除术中外分泌性胰腺功能不全：发生率和危险因素。

背景

外分泌性胰腺功能不全（EPI）是胰腺切除术的已知结果。然而，其远端胰腺切除术后的发生率尚不明确。这项研究的目的是描述进行远端胰切除术的患者中EPI的患病率，并确定远端胰切除术后发展为新型EPI的危险因素。

方法

询问了一个前瞻性维护的机构胰腺切除数据库，以鉴定2005年至2015年接受远端胰腺切除术的患者。分析了手术前后的外分泌功能，组织病理学，人口统计学和胰腺切除量。

结果

该队列包括324例患者，其中22例（6.8％）在术前接受了EPI。38（12.6％）位患者出现了新发的EPI，需要进行胰酶替代治疗。患者的人口统计学特征或糖尿病状况与胰酶替代疗法的需求之间没有关系，并且手术后切除量对胰酶替代疗法的需求没有显着影响（p≥0.05）。具有潜在的梗阻性胰腺病理（p = 0.002）或存在急性胰腺炎的病史（p <0.001）显着预测了新型EPI的发展。

结论

这些结果表明，手术时预先存在的EPI并不少见。进行远端胰切除术的患者应在术前评估是否需要胰酶替代治疗。