Glucose metabolism after pancreatectomy: opposite extremes between pancreaticoduodenectomy and distal pancreatectomy.

CONTEXT The rate of glucose metabolism changes drastically after partial pancreatectomy. OBJECTIVES To analyze the changes in patients' glucose metabolism and endocrine and exocrine function before and after partial pancreatectomy relative to different resection types (Kindai Prospective Study on Metabolism and Endocrinology after Pancreatectomy: KIP-MEP study). METHODS A series of 278 consecutive patients with scheduled pancreatectomy were enrolled into our prospective study. Of them, 109 individuals without diabetes, who underwent partial pancreatectomy, were investigated. Data were compared between patients with pancreaticoduodenectomy (PD, n = 73) and those with distal pancreatectomy (DP, n = 36). RESULTS Blood glucose levels during the 75gOGTT (75-g oral glucose tolerance test) significantly decreased after pancreatectomy in the PD group (area under the curve (AUC) -9.3%, P < 0.01), and significantly increased in the DP population (AUC +16.8%, P < 0.01). Insulin secretion rate during 75gOGTT and glucagon stimulation test significantly decreased after pancreatectomy in both the PD and DP groups (P < 0.001). Both groups showed similar HOMA-IR (homeostasis model assessment of insulin resistance) values after pancreatectomy. Decrease in the exocrine function quality after pancreatectomy was more marked in association with PD than DP (P < 0.01). Multiple regression analysis indicated that resection type and preoperative HOMA-IR independently influenced glucose tolerance-related postoperative outcomes. CONCLUSIONS Blood glucose levels after the OGTT markedly differed between PD and DP populations. The observed differences between PD and DP suggest the importance of individualization in the management of metabolism and nutrition after partial pancreatectomy.