Langenbecks Arch Surg (2017) 402:873–883 DOI 10.1007/s00423-017-1603-8 REVIEW ARTICLE Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia 1,2 2 3 Ajay V. Maker & Raashid Sheikh & Vinita Bhagia & Diabetes Control and Complications Trial (DCCT) Research Group Received: 15 January 2017 /Accepted: 7 July 2017 /Published online: 21 July 2017 Springer-Verlag GmbH Germany 2017 Abstract search of the references of published articles to identify studies Purpose Indications for total pancreatectomy (TP) have in- evaluating endocrine morbidity and treatment after TP and to creased, including for diffuse main duct intrapapillary mucinous establish an evidence-based treatment strategy. neoplasms of the pancreas and malignancy; therefore, the need Results Indications for TP and the etiology of pancreatogenic persists for surgeons to develop appropriate endocrine post- diabetes are reviewed. After TP, ~80% patients develop hypogly- operative management strategies. The brittle diabetes after TP cemic episodes and 40% experience severe hypoglycemia, differs from type 1/2 diabetes in that patients have absolute defi- resulting in 0–8% mortality and 25–45% morbidity. Referral to ciency of insulin and functional glucagon. This makes glucose a nutritionist and endocrinologist for patient education before management challenging, complicates recovery, and predisposes surgery followed by surgical reevaluation to determine if
Langenbeck's Archives of Surgery – Springer Journals
Published: Jul 21, 2017
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