Digestive Diseases and Sciences

, Volume 45, Issue 6, pp 1084–1090 | Cite as

Intraoperative Radiation Enhances Decline of Pancreatic Exocrine Function After Pancreatic Head Resection

  • Koji Yamaguchi
  • Katsumasa Nakamura
  • Masahiko Kimura
  • Kazunori Yokohata
  • Hirokazu Noshiro
  • Kazuo Chijiiwa
  • Masao Tanaka


Intraoperative radiation therapy has been introduced to improve survival rates after resection of biliopancreatic cancer. Early and late effects of intraoperative radiation on the exocrine and endocrine functions of the residual pancreas were examined in 54 patients with pancreatic head resection. Of the 54 patients, 20 underwent intraoperative radiation (A group) and the other 34 did not (B group). Fasting blood sugar level, a 120-min value of the 75-g oral glucose tolerance test, N-benzol-l-tyrosyl-p-aminobenzoic acid (BT-PABA) excretion value (a pancreatic exocrine function test), and amount of postoperative pancreatic juice drainage were compared between groups A and B at preoperative and early and late postoperative times. Fasting blood sugar level and a 120-min value of the 75-g oral glucose tolerance test (OGTT) showed no change at the early (<2 months) postoperative period of the two groups. At the late (>6 months) postoperative period, fasting blood sugar showed no alteration, while the 75-g OGTT 120-min value increased compared to the preoperative level in both groups. In the group A, the 75-g OGTT 120-min value at the late postoperative period was significantly higher than those at the preoperative and early postoperative periods (289.4 ± 104.9 vs 193.0 ± 58.2 mg/dl, P = 0.0198 and 289.4 ± 104.9 vs 184.4 ± 104.9 mg/dl, P = 0.0285). Preoperative BT-PABA excretion value was not different between the two groups. It decreased at the early postoperative period and returned to the preoperative level at the late postoperative period in both the groups. The decline of BT-PABA in group A was 23 ± 21%, which was significantly larger than 11 ± 24% in group B. The total amount of postoperative pancreatic juice drainage from postoperative days (POD) 4–13 in group A was about half as much as that in group B (720.8 ± 916.4 vs 1433.8 ± 962.1 ml, P = 0.0128). Univariate and multivariate regression analysis of factors concerning the decline of BT-PABA values at the early postoperative period showed that intraoperative radiation was a significant independent determinant. In conclusion, these results suggest that intraoperative radiation causes significant deterioration of pancreatic exocrine function at the early postoperative period. Intraoperative radiation for resectable periampullary carcinoma should be reappraised based on the decline of the pancreatic exocrine function as well as the improvement of the survival curve.

intraoperative radiation therapy pancreatic exocrine function pancreatic endocrine function pancreatectomy 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    The Gastrointestinal Tumor Study Group: Therapy of locally unresectable pancreatic carcinoma; A randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. Cancer 48:1705–1710, 1981Google Scholar
  2. 2.
    The Gastrointestinal Tumor Study Group: Treatment of locally unresectable carcinoma of the pancreas: Comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 80:751–755, 1988Google Scholar
  3. 3.
    Komaki R, Wilson F, Cox JD, Kline RW: Carcinoma of the pancreas: Results of irradiation for unresectable lesions. Int J Radiat Oncol Biol Phys 6:209–212, 1908Google Scholar
  4. 4.
    Abe M, Takahashi M: Intraoperative radiotherapy: The Japanese experience. Int J Radiat Oncol Biol Phys 7:863–868, 1981PubMedGoogle Scholar
  5. 5.
    Castro JR, Woodruff KH, Saunders WM, Lyman JT, Quivey JM, Twomey P, Chen GT, Frey C, Collier JM, Phillips TL: Clinical problems in radiotherapy of carcinoma of the pancreas. Am J Clin Oncol 5:579–587, 1982PubMedGoogle Scholar
  6. 6.
    Nishimura A, Nakano M, Otsu H, Nakano K, Iida K, Sakata S, Iwabuchi K, Maruyama K, Kihara M, Okamura T, Todoroki T, Iwasaki Y: Intraoperative radiotherapy for advanced carcinoma of the pancreas. Cancer 54:2375–2384, 1984PubMedGoogle Scholar
  7. 7.
    Shipley WU, Wood WC, Tepper JE, Warshaw AL, Orlow EL, Kaufman D, Battit GE, Nardi GL: Intraoperative electron beam irradiation for patients with unresectable pancreatic carcinoma. Ann Surg 200:289–296, 1984PubMedGoogle Scholar
  8. 8.
    Ishikawa O, Ohigashi H, Imaoka S, Teshima T, Inoue T, Sasaki Y, Iwanaga T, Nakaizumi A: Concomitant benefit of preoperative irradiation in preventing pancreas fistula formation after pancreatoduodenectomy. Arch Surg 126:885–889, 1991PubMedGoogle Scholar
  9. 9.
    Imondi AR, Stradley RP, Wolgemuth R: Synthetic peptides in the diagnosis of exocrine pancreatic insufficiency in animals. Gut 13:27–32, 1972Google Scholar
  10. 10.
    Lankisch PG: Exocrine pancreatic function tests. Gut 23:777–798, 1982PubMedGoogle Scholar
  11. 11.
    Niederau C, Grendell JH: Diagnosis of chronic pancreatitis. Gastroenterology 26:1257–1262, 1985Google Scholar
  12. 12.
    Alberti KGMM, Hochaday TAR: Diabetes mellitus. InOxford Textbook of Medicine. DJ Weatherall, YGG Ledingham, DA Warrell (eds). New York; Oxford Medical, 1987Google Scholar
  13. 13.
    Tanaka T, Ichiba Y, Fujii Y, Kodama O, Dohi K: Clinical and experimental study of pancreatic exocrine function after pancreaticoduodenectomy for periampullary carcinoma. Surg Gynecol Obstet 166:200–205, 1988PubMedGoogle Scholar
  14. 14.
    Matsuno S, Tanaka K, Miyashita E, Miyagawa K, Imamura M, Sato T: Pancreatic function and rehabilitation after pancreaticoduodenectomy. Jpn J Surg 18:23–30, 1988PubMedGoogle Scholar
  15. 15.
    Kodama M, Tanaka T: Residual pancreatic exocrine function before and after pancreaticoduodenectomy for periampullary cancer. World J Surg 8:335–339, 1983Google Scholar
  16. 16.
    Hall RI, Rhodes M, Isable-Martinez L, Kelleher J, Venables CW: Pancreatic exocrine function after a sutureless pancreatico-jejunostomy following pancreatico-duodenectomy. Br J Surg 77:83–85, 1990PubMedGoogle Scholar
  17. 17.
    Kendall DM, Sutherland DER, Najarian JS, Goetz FC, Robertson RP: Effects of hemipancreatectomy on insulin secretion and glucose metabolism tolerance in healthy humans. N Engl J Med 322:898–903, 1990PubMedGoogle Scholar
  18. 18.
    Miyata M, Takao T, Okamoto E, Manabe H: An appraisal of radical pancreatoduodenectomy based on insulin secretion. Am J Surg 133:577–581, 1977PubMedGoogle Scholar
  19. 19.
    Ahren B, Andren-Sandberg A: Capacity to secrete islet hormones after subtotal pancreatectomy for pancreatic cancer. Eur J Surg 159:223–227, 1993PubMedGoogle Scholar
  20. 20.
    Permert J, Ihse I, Jorfeldt L, vonSchenk H, Arnquist HJ, Larsson J: Improves glucose metabolism after subtotal pancreatectomy for pancreatic cancer. Br J Surg 80:1047–1050, 1993PubMedGoogle Scholar
  21. 21.
    Rauch RF, Stenstrom KW: Effects of x-ray radiation on pancreatic function in dogs. Gastroenterology 20:595–603, 1952PubMedGoogle Scholar
  22. 22.
    Pieroni PL, Rudick J, Adler M, Nacchiero M, Rybak BJ, Perlberg H, Dreiling DA: Effect of irradiation on the canine exocrine pancreas. Ann Surg 184:610–614, 1976PubMedGoogle Scholar
  23. 23.
    Orndoff BH, Farrell JI, Ivy AC: Studies on the effect of roentgen rays on glandular activity. V. The effect of roentgen rays on the external pancreatic secretion. Am J Roentgenol 16:349–354, 1926Google Scholar
  24. 24.
    Bagne FR, Samsami N: Radiation contamination and leakage asessment of intraoperative electron applicators. J Med Phys 15:530–537, 1988Google Scholar

Copyright information

© Plenum Publishing Corporation 2000

Authors and Affiliations

  • Koji Yamaguchi
    • 1
  • Katsumasa Nakamura
    • 1
  • Masahiko Kimura
    • 1
  • Kazunori Yokohata
    • 1
  • Hirokazu Noshiro
    • 1
  • Kazuo Chijiiwa
    • 1
  • Masao Tanaka
    • 1
  1. 1.Departments of Surgery and Oncology and Clinical Radiology, Graduate School of Medical SciencesKyushu University Faculty of MedicineFukuokaJapan

Personalised recommendations