STUDIO DI VALUTAZIONE A LUNGO TERMINE DELLA FUNZIONE ESOCRINA E DEI VOLUMI PANCREATICI RESIDUI IN PAZIENTI SOTTOPOSTI A CHIRURGIA RESETTIVA

Introduction. The anastomosis of the residual pancreas with digestive tract after pancreaticoduodenectomy (PD) is a critical aspect in the management of the surgical patient that can affect many variables ranging from the quality of life to the development of exocrine pancreatic insufficiency. The standard technique of pancreo-jejunal-anastomosis (PJ) is often replaced by pancreo-gastro-anastomosis (PG), more easy to perform and with fewer complications. There is no long-term study of comparison between the two types of anastomosis. Material and Methods. We evaluated 31 patients after duodeno-cefalo-pancreatectomy (DCP) for pancreatic tumor from 2001 to 2006. All were hospitalized and submitted to morphological and functional studies. We studied the pancreatic volume and the diameter of the main pancreatic duct (MRI), the exocrine function of the pancreas (fecal fat, fecal-elastase and vitamin D) and endocrine function. The quality of life was assessed using the EORTC QLQ-C30. It was reported the mean ± 1 standard error. The normality of the distribution was investigated by the Kolmogorov-Smirnov test and the correlation between independent variables by the Bravais-Pearson test. Results. We studied 31 patients (15 with PG and 16 PJ). No difference was found in the duration of follow-up, BMI, endocrine function, symptom scores and quality of life. The exocrine pancreatic function is worse after PG than after PJ (steatorrhea 26.6 ± 4.1 vs 18.2 ± 3.6 g/day; FE-1 170.2 ± 25.5 vs 121.4 ± 6.7 µg/g). There is a reduction of vitamin D (higher in PG compared to PJ) (18.1 ± 1.8 vs 23.2 ± 3.1 ng / ml). The MRI showed a severe reduction in the residual pancreatic volume (lower in PG than PJ: 26±3.1 vs 36±4.1 ml), and an increase in the diameter of the pancreatic duct after PG (4.6 ± 0.92 vs 2.4 ± PJ of 0.18 mm), indicative of obstructive pancreatitis. Conclusion. After DCP there is a marked reduction both of the residual pancreatic volume both of the functional capacity of the pancreas which lead to steatorrhea. In the long term no differences in quality of life was found between operated patients and controls. Digestive symptoms suggestive of malabsorption or malnutrition not differ from that observed in a "normal" population-patient. However there is frequently a lack of important micronutrients, such as vitamin D and all patients needed important enzyme replacement, regardless of the set of symptoms presented