Pylorus-preservation Decreases the Extent of Atrophy of Remnant Pancreas after Pancreatoduodenectomy

Kim, Sun Whe; Kim, Ki Hwan; Han, Joon Koo; Park, Yong Hyun

Abstract

BACKGROUND: A pylorus-preserving pancreatoducdenectomy (PPPD) preserves the secretion of gastrointestinal (GI) hormones from the distal stomach and the duodenum, whereas they are no longer secreted after standard pancreato-duodenectomy (PD). It has been suggested that some GI hormones exert a trophic effect on the pancreas, though this has not been documented in humans. We postulate that the ablation of GI hormones, such as gastrin and cholecystokinin (CCK) by PD is an important cause of postoperative pancreatic atrophy, and since PPPD preserves the secretion of these hormones, it will be more effective than PD for the maintenance of postoperative pancreatic volume. PURPOSE: To determine whether pylorus preservation after PD affects the volume of the remnant pancreas in long-term survivors, and whether such an effect, is related to the continued secretion of GI hormones following preservation of the pylorus. MATERIALS & METHODS: We measured the postoperative pancreatic volume and the release of gastrin and CCK in patients who had undergone PD or PPPD performed by the same surgeon and survived one year or longer without recurrence. For volumetry, thin-section spiral CT with three-dimensional display was performed; suitable hormone release was measured by radioimmunoassay using antibodies.
RESULTS
After PPPD, the pancreatic volume and the gastrin release were significantly greater than after PD and there was a significant correlation between pancreatic volume and stimulated gastrin release. The pancreatic volume was not related to other clinical factors such as type of reconstruction, age, postoperative interval, or nutritional status.
CONCLUSION
We have demonstrated that the volume of distal remnant pancreas is greater after PPPD than after PD, and suggest that this is due to preservation by PPPD of GI hormones, which may exert a trophic effect on the pancreas.