Analysis of Clinical Courst after Total Pancreatectomy: A Guideline for Blood Glucose Control and Nutritional Support

Hwang, Shin; Lee, Sung Gyu; Han, Duck Jong; Lee, Young Joo; Park, Kwang Min; Min, Pyung Chul

Abstract

BACKGROUND/AIMS: Totally pancreatectmized patients have suffered from brittle diabetes and rnetabolic derangements as well as operative complications. We compared total pancreatectomy with pancreatoduodenectomy regarding operative complications and analyzed metabolic consequ- ences to figure out a guideline for their management.
METHODS
Retrospective study was performed in 25 totally pancreatectomized cases and 234 pancreaticoduodenectomy cases.
RESULTS
Complica- tion rate after total pancreatectomy was 16% and showed no difference with that of pancreati- coduodenectomy. Diarrhea or steatorrhea had occurred in 44% at immediate postoperative period, and has been controlled within 5 months in 92%. Marked body weight reduction and poor nutritional status were observed in most cases. Blood glucose was not controlled wel] enough, and hypoglycemic episodes or diabetic ketoacidosis were experienced in 56%. There were 3 rnortalities due to complicated hypoglycemia. Insulin requirements were started to be stabilized at 14th day and maintained well after 3 months postoperation.
CONCLUSIONS
As malnutrition and brittle diabetes often occurred in totally pancreatectomized patients, we propose a guideline for diabetic control by insulin dosage setting and prevention of rnetabolic sequelae by nutritional supports.