Surgical alterations of the pancreas and insulin-independent glucose disposal

Mini-Review on the Glucose Metabolism Modifications after Pancreatic Resection

Pancreatic cancer is one of the most severe malignant disease, with an extreme degree of lethality, considering that the survival rate at 5 years is up to 4%. In addition, a major disadvantage of this disease is the fact that the diagnosis is determined very late in the evolution of the disorder, despite the development of new technologies. In this way, the main symptoms are occurring later on, when the tumour is already locally advanced and unresectable. Up to now surgery is the only modality that can provide a greater chance of survival, but unfortunately the pancreatic resection has many unknowns and controversies around it. Moreover, the studies on endocrine pancreatic function after resection are very few and somehow controversial. In this way, in the present mini-review we will describe the most relevant experimental data regarding the post-resection pancreatogenic diabetes, the pancreatic polypeptide PP and the pancreatic glucose metabolism after resection or the glucose metabolism after partial or total pancreatectomy.

Mini-Review on the Glucose Metabolism Modifications after Pancreatic Resection

Pancreatic cancer is one of the most severe malignant disease, with an extreme degree of lethality, considering that the survival rate at 5 years is up to 4%. In addition, a major disadvantage of this disease is the fact that the diagnosis is determined very late in the evolution of the disorder, despite the development of new technologies. In this way, the main symptoms are occurring later on, when the tumour is already locally advanced and unresectable. Up to now surgery is the only modality that can provide a greater chance of survival, but unfortunately the pancreatic resection has many unknowns and controversies around it. Moreover, the studies on endocrine pancreatic function after resection are very few and somehow controversial. In this way, in the present mini-review we will describe the most relevant experimental data regarding the post-resection pancreatogenic diabetes, the pancreatic polypeptide PP and the pancreatic glucose metabolism after resection or the glucose metabolism after partial or total pancreatectomy.

The effect of venous drainage on glucose homeostasis after experimental pancreas transplantation

In this canine study, glucose homeostasis after clinical pancreas transplantation is complex, with the relative effect of systemic versus portal delivery of insulin remaining unresolved. Thirty-two pancreatectomized dogs received either systemic venous drainage (SVD) with bladder exocrine drainage (n = 16), or portal venous drainage (PVD) with gastric exocrine drainage (n = 16). Cyclosporine (CsA) based immunosuppression was commenced on day -7. The effect of immunosuppression was a significant increase in fasting blood glucose (FBGL) (P = 0.002), fasting insulin (P = 0.024), AUC for insulin (P = 0.009), and K values decreased (P = 0.009). FBGL and K values remained abnormal after transplantation with no significant difference seen between SVD and PVD. However, fasting insulin became significantly lower after PVD and AUC insulin fell in both groups. CsA levels fell in both groups after transplantation, mirroring the fall in AUC insulin, and implicating CsA as a major cause of peripheral resistance to insulin. In conclusion, PVD did not demonstrate a significant advantage over SVD in handling an intravenous glucose challenge. The need for pancreatectomy in large animals may make them an unsatisfactory experimental model to evaluate the glucoregulatory effects of pancreas allotransplantation.