From the Guidelines
The sequelae of total pancreatectomy include several significant metabolic and digestive consequences, and patients should be considered for islet autotransplantation to prevent postsurgical diabetes, as approximately one-third of patients undergoing this procedure with islet autotransplantation are insulin free 1 year postoperatively 1. The complications of total pancreatectomy are multifaceted, affecting both endocrine and exocrine functions of the pancreas. Patients develop brittle diabetes mellitus due to the complete loss of insulin and glucagon production, necessitating intensive insulin therapy, typically basal-bolus regimens with both long-acting insulin like glargine and short-acting insulin like lispro. This form of diabetes is particularly challenging to manage due to the absence of counter-regulatory hormones. Some key considerations for managing these patients include:
- Exocrine pancreatic insufficiency, which necessitates lifelong pancreatic enzyme replacement therapy (PERT) with products like pancrelipase, with a typical starting dose of 25,000-40,000 units of lipase with meals and 10,000-25,000 units with snacks.
- Malabsorption of fat-soluble vitamins (A, D, E, K), which requires supplementation and regular monitoring of vitamin levels.
- Significant weight loss, malnutrition, and steatorrhea if enzyme replacement is inadequate.
- Gastrointestinal symptoms like early satiety, altered bowel habits, and abdominal discomfort are common. Additionally, patients may develop osteoporosis due to calcium malabsorption and require bone density monitoring, and the absence of pancreatic polypeptide can lead to hepatic insulin resistance and fatty liver disease, as noted in standards of medical care in diabetes 1. Given the potential benefits of islet autotransplantation in preventing postsurgical diabetes, it is crucial to consider this option for patients requiring total pancreatectomy for medically refractory chronic pancreatitis, as it may improve their quality of life and reduce the morbidity associated with total pancreatectomy 1.
From the Research
Sequelae of Total Pancreatectomy
The sequelae of total pancreatectomy can be significant and varied. Some of the key sequelae include:
- Diabetes: Total pancreatectomy results in the complete removal of the pancreas, leading to a loss of insulin production and resulting in diabetes 2, 3.
- Malabsorption: The pancreas plays a crucial role in digestion and absorption of nutrients. Total pancreatectomy can lead to malabsorption of fats and other nutrients, requiring pancreatic enzyme replacement therapy 4, 5.
- Hypoglycemia: Patients who have undergone total pancreatectomy are at risk of hypoglycemia due to the loss of glucagon production, which can make glucose management challenging 3.
- Metabolic disorders: Total pancreatectomy can lead to various metabolic disorders, including diabetes, malabsorption, and hypoglycemia, which can have a significant impact on the patient's quality of life 6.
Management of Sequelae
The management of sequelae after total pancreatectomy requires a multidisciplinary approach, including:
- Insulin therapy: Patients with diabetes after total pancreatectomy require insulin therapy to manage their blood glucose levels 2, 3.
- Pancreatic enzyme replacement therapy: Patients who have undergone total pancreatectomy require pancreatic enzyme replacement therapy to manage malabsorption and maintain nutritional status 4, 5.
- Dietary management: Patients who have undergone total pancreatectomy require dietary management to ensure adequate nutrition and prevent malabsorption 4, 5.
- Close monitoring: Patients who have undergone total pancreatectomy require close monitoring of their blood glucose levels, nutritional status, and overall health to prevent and manage complications 2, 3.