Volume and Functional Changes of Remnant Pancreas After Different Types of Pancreatectomy: Exploring the Regenerative Potential
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Objective The evidence on the regeneration and functional changes of remnant pancreas after pancreatectomy is limited. Herein, we conducted a prospective study to investigate the correlation between changes in volume and endocrine function of the remnant pancreas. Design: Patients undergoing pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) from Jan. 2009 to Dec. 2017 were included. Computed tomography was used to determine the volume of remnant pancreas at 3 months, 1 year, and 2 years after pancreatectomy. The postoperative changes of endocrine function were also assessed. RESULTS Finally, 90 PD patients and 45 DP patients were enrolled. The remnant pancreas volume at 3 months, 1 year and 2 years compared with initial residual pancreas were 80.79%, 68.67% and 65.34% respectively (p < 0.001) in the PD patients; 106.25%, 106.62% and 110.43% (p = 0.019) in the DP patients. The DP patients have higher incidence of new-onset diabetes than PD patients (33.3% vs. 22.7%). More P-duct dilatation with severe atrophy of the remnant pancreas (p = 0.027) in the PD patients, while better volume preservation and growth (p = 0.084) in the DP patients with spleen preservation. The changes of pancreas volume didn't correlate with postoperative new-onset DM. Interestingly, PD group had greater restoration of endocrine function than DP group based on secretion of C-peptide (β ± SE: 13.26 ± 5.50, p = 0.016). CONCLUSION Remnant pancreas exhibits distinct volumetric changes with significant volume increase in DP patients but progressive volume decreases in PD patients. Despite better volume preservation in DP group, the head portion of pancreas in PD group demonstrated superior β-cell function restoration, corresponding with lower incidence of new-onset diabetes.
