Our Summary

This research paper examines the long-term negative effects on metabolism that can occur after a particular type of surgery called pancreatoduodenectomy (PD), where the head of the pancreas and the duodenum are removed. The researchers looked at data from 23 studies involving over 1000 patients.

They found that a significant number of these patients developed new cases of diabetes (pNODM) and digestive disorders (PEI) after the surgery. Specifically, 14% of patients developed diabetes and 44% developed digestive issues.

The paper also compared PD surgery with another type of surgery called duodenum-sparing total pancreatic head resection (DPPHR). The results showed that patients who underwent DPPHR were much less likely to develop diabetes or digestive issues after surgery.

The researchers also found that PD surgery significantly impaired the body’s response to several hormones that are crucial for digestion and insulin regulation. However, DPPHR surgery did not show these negative effects.

The conclusion is that the removal of the duodenum is the main factor causing these long-term metabolic issues. Therefore, when long-term survival is expected, surgeons should consider alternatives to PD that spare the duodenum.

FAQs

  1. What is pancreatoduodenectomy (PD) surgery and what are its long-term effects?
  2. How does duodenum-sparing total pancreatic head resection (DPPHR) surgery compare to PD surgery in terms of causing diabetes and digestive issues?
  3. What is the main factor causing long-term metabolic issues after PD surgery?

Doctor’s Tip

A doctor might tell a patient undergoing a Whipple procedure to be aware of the potential long-term effects on metabolism, such as the development of diabetes and digestive issues. They may recommend considering alternative surgeries that spare the duodenum, such as duodenum-sparing total pancreatic head resection, to minimize these risks. Additionally, patients should follow a healthy diet and lifestyle post-surgery to support their overall health and well-being.

Suitable For

Patients who are typically recommended the Whipple procedure (pancreatoduodenectomy) are those with pancreatic cancer, bile duct cancer, ampullary cancer, or neuroendocrine tumors of the pancreas or duodenum. Additionally, the Whipple procedure may be recommended for patients with chronic pancreatitis that has not responded to other treatments.

It is important to note that the decision to undergo the Whipple procedure is made on a case-by-case basis, taking into consideration the patient’s overall health, the stage and location of the cancer, and other factors. The Whipple procedure is a complex surgery with potential risks and complications, so it is important for patients to discuss the potential benefits and risks with their healthcare team before making a decision.

Timeline

Before the Whipple procedure:

  • Patient undergoes various tests and scans to diagnose the condition requiring surgery
  • Patient may experience symptoms such as abdominal pain, jaundice, weight loss, and digestive issues
  • Patient consults with a surgeon to discuss the procedure and potential risks and benefits
  • Pre-operative preparations are made, including fasting and medication adjustments
  • Surgery is performed, which typically lasts several hours and involves removing a portion of the pancreas, duodenum, gallbladder, and sometimes part of the stomach
  • Patient stays in the hospital for a period of time to recover from surgery

After the Whipple procedure:

  • Patient may experience pain, fatigue, and discomfort in the immediate post-operative period
  • Patient gradually resumes eating and drinking, starting with clear fluids and progressing to solid foods
  • Patient receives pain medication, antibiotics, and other medications as needed
  • Patient is monitored for complications such as infection, bleeding, and delayed gastric emptying
  • Patient undergoes follow-up appointments and tests to monitor recovery and assess for any long-term issues
  • Patient may experience changes in digestion, weight, and overall health due to the altered anatomy and function of the digestive system
  • Patient may need to make dietary and lifestyle adjustments to manage these changes and maintain overall health and well-being.

What to Ask Your Doctor

  1. What are the potential long-term complications of a Whipple procedure, specifically in terms of metabolism?

  2. How likely am I to develop new cases of diabetes or digestive issues after undergoing a Whipple procedure?

  3. Are there any alternative surgical options, such as duodenum-sparing total pancreatic head resection, that could potentially reduce the risk of long-term metabolic issues?

  4. How will my body’s response to hormones crucial for digestion and insulin regulation be affected by a Whipple procedure?

  5. What steps can I take post-surgery to minimize the risk of developing diabetes or digestive issues?

  6. Are there any specific dietary or lifestyle changes I should make post-surgery to support my metabolism and overall health?

  7. How often should I follow up with my healthcare provider to monitor for any potential long-term metabolic issues after a Whipple procedure?

  8. What are the signs and symptoms I should watch out for that may indicate a complication related to metabolism after the surgery?

  9. Are there any medications or treatments available to help manage any long-term metabolic issues that may arise after a Whipple procedure?

  10. How can I best advocate for myself in terms of receiving appropriate care and support for any potential metabolic issues that may develop post-surgery?

Reference

Authors: Beger HG, Mayer B, Poch B. Journal: HPB (Oxford). 2020 Jun;22(6):809-820. doi: 10.1016/j.hpb.2019.12.016. Epub 2020 Jan 23. PMID: 31983660