Postgastrectomy Changes in the Pancreatic Volume at Computed Tomography Examinations

  • Koray Kılıç Gazi University School of Medicine
  • Dilan Ece Geylan Durgun Gazi University School of Medicine
  • Melih Akyüz Gazi University School of Medicine
  • Gonca Erbaş Gazi University School of Medicine

Abstract

Objective: We aim to determine the volume changes of the pancreas after gastrectomy by using volumetric computed tomography (CT) measurements. Methods:Thirteen patients (8 men, 5 women, age range: 42 y – 76 y) who were diagnosed with gastric cancer and underwent gastrectomy (2 subtotal, 11 total) were included in this retrospective study. Pancreatic volumes were measured in preoperative (Pvolpre) and postoperative (3rd month (Pvol1stFU), 7-11th month (Pvol2ndFU), and 18-60th month (Pvol3rdFU) follow-up) contrast-enhanced CT examinations. To calculate the pancreatic volume, first, we manually drew the outermost margins of the pancreas and cut the volume, then we used a threshold method to exclude fat densities that infiltrated the pancreas. We used the Shapiro -Wilk test for normality, Levene test for homogeneity and one-way ANOVA test for comparing multiple groups.  The significance level of 0.05 is used. Results:Pancreatic volumes decreased significantly within the 3rd month after the surgery in all of the patients (Pvolpre: 87,6 cc, Pvol1stFU: 60,4 cc, p=0.044). The differences in the pancreas volumes between first, second and third follow-up examinations were not significant (p > 0.05 for all). Conclusion:This study demonstrated that pancreas volume significantly decreases after gastrectomy and the decrease could be well documented with volumetric CT.  The decrease in the volume is more evident in the 3rd month follow up period. A radiologist should be aware of an expected decrease in the volume of the pancreas in the follow-up after gastrectomy.

Author Biographies

Koray Kılıç, Gazi University School of Medicine
Department of Radiology
Dilan Ece Geylan Durgun, Gazi University School of Medicine
Department of Radiology
Melih Akyüz, Gazi University School of Medicine
Department of Radiology
Gonca Erbaş, Gazi University School of Medicine
Department of Radiology

References

References:

Eroğlu H, Zihni İ, Çağlar K, Karaköse O, Pülat H, Eken H. A Retrospective Study of Gastric Cancer Cases Gazi Medical Journal. 2017;28:4-7.

Schafmeyer A, Kohler H, Nustede R, Bittner R, Buchler M, Kluge HJ, et al. Does the preservationof the duodenal passage provideclinical and metabolic advantages for the patient. Nutrition. 1988;4:311-3.

Kalmar K, Nemeth J, Kelemen D, Agoston E, Horvath OP. Postprandial gastrointestinal hormone production is different, depending on the type of reconstruction following total gastrectomy. Annals of surgery. 2006;243:465-71.

Dembinski AB, Johnson LR. Stimulation of pancreatic growth by secretin, caerulein, and pentagastrin. Endocrinology. 1980;106:323-8.

Johnson LR. Effects of gastrointestinal hormones on pancreatic growth. Cancer. 1981;47:1640-5.

Kim SW, Kim KH, Park SJ, Her HH, Jang JY, Park YH. Endogenous gastrin stimulates regeneration of remnant pancreas after partial pancreatectomy. Digestive diseases and sciences. 2001;46:2134-9.

Hopman WP, Jansen JB, Lamers CB. Plasma cholecystokinin response to oral fat in patients with Billroth I and Billroth II gastrectomy. Annals of surgery. 1984;199:276-80.

Watanapa P, Flaks B, Oztas H, Deprez PH, Calam J, Williamson RC. Enhancing effect of partial gastrectomy on pancreatic carcinogenesis. British journal of cancer. 1992;65:383-7.

Buchler M, Malfertheiner P, Glasbrenner B, Beger HG. Rat exocrine pancreas following total gastrectomy. International journal of pancreatology : official journal of the International Association of Pancreatology. 1986;1:389-98.

Hugh McLean Ross A, A. Smith M, R. Anderson J, P. Small W. Late Mortality after Surgery for Peptic Ulcer1982. 519-22 p.

Offerhaus G, Giardiello FM, Moore GW, Tersmette AC. Partial gastrectomy: A risk factor for carcinoma of the pancreas?1987. 285-8 p.

Caygill C, J Hill M, N Hall C, S Kirkham J, C Northfield T. Increased risk of cancer at multiple sites after gastric surgery for peptic ulcer1987. 924-8 p.

Buchler M, Malfertheiner P, Friess H, Nustede R, Feurle GE, Beger HG. Cholecystokinin influences pancreatic trophism following total gastrectomy in rats. International journal of pancreatology : official journal of the International Association of Pancreatology. 1989;4:261-71.

Published
2019-12-21
Section
Original Research