An appraisal of radical pancreatoduodenectomy based on insulin secretion.

The effect of pancreatoduodenectomy on insulin secretion was determined in seven patients with periampullary malignant tumors. As a uniform stimulus for secreting insulin, 100 gm of glucose was administered orally to all patients and glucose tolerance tests were carried out. Glucose intolerance and poor insulin secretion were obvious both pre- and postoperatively. Indexes of an initial insulin response, of a maximum insulin increment, and of total secretion of insulin responding to the stimulus of glucose were significantly lower in these patients before and after pancreatoduodenal resection, as compared with normal subjects. It was also observed that these three indexes, which express the ability of the pancreas to secrete insulin, decreased without exception after pancreatoduodenectomy. In light of these data it is postulated that radical pancreatoduodenectomy further diminishes the already insufficient secretion of insulin indicated by the oral glucose tolerance test in patients with periampullary malignant tumors.