Pancreatic exocrine function is preserved after distal pancreatectomy

Our objective was to measure human stool elastase-1 to determine the effect of distal pancreatectomy on exocrine function.

During a 72-month period, 115 patients underwent resection. Stool elastase values were measured preoperatively in 83 patients and repeated at 3, 12, and 24 months. The amount of pancreas resected was divided into two categories-limited to the left of the portal vein and those resections over or extended to the right of the vein.

Elastase values were normal in 84% (n = 70) of cases prior to resection (33% if chronic pancreatitis, 70% if pancreatic adenocarcinoma). In the 70 patients with normal preoperative values, exocrine function was maintained in those with resection that was limited to the left of the portal vein at 3, 12, and, 24 months. If the resection was over or extended to right of the portal vein, then 88% maintained normal exocrine function at 3 months, 92% at 12 months, and 100% were normal at 24 months.

Of patients undergoing distal pancreatectomy, one sixth will have preoperative pancreatic insufficiency, most commonly those with pancreatic adenocarcinoma or chronic pancreatitis. Postoperative pancreatic insufficiency was seen transiently in those with resection that extended to the portal vein or beyond.