Endocrine and Exocrine Dysfunction After Pancreatic Resection: Decoding Postoperative Glucose Homeostasis
Suresh K. Arjun, Ramesh Rajan, Abilash Nair, Santhoshkumar Subramaniam, Raheef P. Pattilath, Bima A. Maheen, Chaithanya K.M. ReddyAbstract
Introduction:
There is limited literature on changes in glucose metabolism and insulin resistance after different types of pancreatic resections, especially with regard to the Indian population. This study aims to evaluate changes in insulin resistance, endocrine and exocrine functions after different types of pancreatectomy.
Methods:
All consecutive patients undergoing pancreatic resection in our department between January 2024 and June 2025 were enrolled in the study. Patients with chronic pancreatitis were excluded. Endocrine function was assessed preoperatively and at one month postoperatively for insulin secretion and insulin resistance using insulinogenic index and homeostatic model assessment for insulin resistance (HOMA-IR), respectively. Factors associated with endocrine insufficiency were analysed.
Results:
During the study period, 49 patients underwent pancreatectomy; 44 were enrolled in the study. Pancreaticoduodenectomy (PD) was performed in 26 (59.1%) and distal pancreatectomy (DP) in 18 (40.9%). Endocrine insufficiency was observed in 20 (45.5%) patients and was significantly associated with preoperative biliary stenting and smoking. A significant improvement in insulin resistance (HOMA-IR) was noted postoperatively, especially after PD (
Conclusion:
Endocrine insufficiency was found to be higher in patients undergoing PD, with factors associated with obstructive pancreatitis posing as risk factors. There is higher insulin resistance in patients undergoing PD, with significant improvement post-surgery, still not reaching normal levels.