Safety of artificial pancreas in hepato-biliary-pancreatic surgery: A prospective study

Abstract

Background: An artificial pancreas (AP) is useful for intensive insulin treatment (IIT). In this study, the safety and efficacy of an AP in the perioperative period of highly invasive hepato-biliary and pancreatic surgery (HBPS) was validated. Methods: Fifty patients underwent IIT with an AP during the HBPS perioperative period, including hepatectomy greater than two sectors (MH), pancreatoduodenectomy (PD), and liver transplantation (LT). The primary endpoint was occurrence of hypoglycemia (<60 mg/dL). Secondary endpoints were perioperative glycemic control and postoperative complications. This study was registered at UMIN-CTR (UMIN000016451). Results: The mean patient age was 62.8 years. The most common surgical procedures were PD (n=24, 48%), MH (n=22, 44%), and LT (n=4, 8%). No hypoglycemia occurred in this study. The mean glycemic control rate and coefficient of variation of blood glucose during AP use were 26.4 ± 21.2% and 16.2 ± 8.3, respectively. The mean blood glucose level was 122.9 ± 15.7 mg/dL during AP application. Conclusion: The AP was safe during IIT, with no hypoglycemia observed perioperatively in patients who underwent highly invasive HBPS. Further studies are required to address the efficacy of AP with IIT in highly invasive situations. Keywords: Artificial organ, Glucose tolerance, Infectious complication, Insulin resistance, Perioperative care