Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
Department of Gastroenterological Surgery, Tsukuba Medical Center Hospital, 1-3-1 Amakubo, Tsukuba, Ibaraki, 305-8558, Japan.
Pancreatology. 2020 Jul;20(5):867-874. doi: 10.1016/j.pan.2020.06.018. Epub 2020 Jul 4.
Pancreatectomy may cause serious pancreatic exocrine insufficiency (PEI), which can lead to some nutritional problems, including new-onset diabetes mellitus (DM) or non-alcoholic fatty liver disease (NAFLD). Recent studies have reported that remnant pancreatic volume (RPV) significantly influences postoperative PEI. However, the specific correlation between RPV and postoperative PEI remains unclear. Here, we compare various pre-, peri-, and postoperative risk factors in a retrospective cohort to address whether preoperatively measured RPV is a predictor of postoperative PEI in pancreatic cancer patients after distal pancreatectomy (DP).
Sixty-one pancreatic cancer patients who underwent DP were retrospectively enrolled. Pancreatic volume was measured using preoperative 3D images, which simulated the actual intraoperative pancreatic parenchymal volume. We obtained the 3D-measured RPV and resected pancreatic volume. We calculated the ratio of the RPV to the total pancreatic volume and then divided the cohort into high- and low-RPV ratio groups based on a cut-off value (>0.35, n = 37 and ≤ 0.35, n = 24). Using multivariate analysis, the RPV ratio as well as pre-, peri- and postoperative PEI risk factors were independently assessed.
The multivariate analysis revealed that a low RPV ratio (odds ratio [OR], 5.911; p = 0.001), a hard pancreatic texture (OR, 3.313; p = 0.023) and TNM stage III/IV (OR, 3.515; p = 0.031) were strong predictors of the incidence of PEI.
The present study indicates that the RPV ratio is an additional useful predictor of postoperative nutrition status in pancreatic cancer patients.
胰腺切除术可能导致严重的胰腺外分泌功能不全（PEI），从而导致一些营养问题，包括新发糖尿病（DM）或非酒精性脂肪性肝病（NAFLD）。最近的研究报告称，残胰体积（RPV）显著影响术后 PEI。然而，RPV 与术后 PEI 之间的确切相关性尚不清楚。在这里，我们比较了回顾性队列研究中的各种术前、术中和术后危险因素，以确定在远端胰腺切除术（DP）后胰腺癌患者中，术前测量的 RPV 是否是术后 PEI 的预测因子。
回顾性纳入 61 例接受 DP 的胰腺癌患者。使用术前 3D 图像测量胰腺体积，该图像模拟了实际术中胰腺实质体积。我们获得了 3D 测量的 RPV 和切除的胰腺体积。我们计算了 RPV 与总胰腺体积的比值，然后根据截值（>0.35，n=37 和≤0.35，n=24）将队列分为高和低 RPV 比值组。使用多变量分析，独立评估 RPV 比值以及术前、术中和术后 PEI 的危险因素。
多变量分析显示，低 RPV 比值（比值比 [OR]，5.911；p=0.001）、硬胰腺质地（OR，3.313；p=0.023）和 TNM 分期 III/IV（OR，3.515；p=0.031）是 PEI 发生率的强预测因子。
本研究表明，RPV 比值是预测胰腺癌患者术后营养状况的另一个有用指标。
