Perioperative glycemic and nutritional management of 32 patients undergoing total pancreatectomy

Abstract

Perioperative glycemic and nutritional management improves quality of life and improves a patient's prognosis. We retrospectively reviewed 32 patients who underwent total pancreatectomy (TP) performed from January 2008 to January 2020. We evaluated blood glucose and nutritional status preoperatively and at one year postoperatively and analyzed the relationship with surgical outcomes. Of 32 patients who underwent TP, 16 were one-stage TP and 16 were two-stage TP. Of 48 lesions, 38 were intraductal papillary mucinous neoplasms and invasive pancreatic ductal carcinoma. The 5-year survival rate was 60%, with no significant difference between one-stage and two-stage TP. The mean preoperative HbA1c was 6.7% which significantly increased to 7.7% postoperatively. The prognostic nutritional index (PNI) was 47.8 preoperatively which significantly decreased to 43.0 postoperatively. In univariate analysis of prognostic factors, one year postoperative neutrophile-lymphocyte ratio, preoperative platelet-lymphocyte ratio, and one year postoperative PNI were identified as significant factors. Multivariate analysis showed that postoperative PNI was a significant prognostic factor. The prognosis was significantly worse in the group with PNI <40.5. The prognosis was significantly improved in patients who received high-titer pancreatin. Since TP completely eliminates pancreatic endocrine and exocrine function, concurrent administration of insulin and exocrine replacement therapy based on a correct understanding of the pathological condition is important.