Long-term effects on the regulation of pancreatic secretion after gastric surgery

Background: Apart from smoking, known risk factors for the development of p ancreatic carcinoma are few, gastric resection being proposed as one. The t rophic effect of cholecystokinin (CCK) on the pancreatic gland is well know n from animal experience and increased concentrations of CCK in plasma have been shown to induce pancreatic neoplasia experimentally. In several studi es the release of CCK in response to food ingestion has been shown to be in creased following gastric surgery. However, in those studies, the time betw een surgery and investigation of the CCK response was short, and methods of CCK analysis have since improved. Patients and Methods: In patients, parti ally gastrectomized 8 years (median) earlier, we studied the plasma concent rations of CCK, insulin and gastrin, as well as some specific pancreatic en zymes. The findings were compared to an age-matched control group of indivi duals not subjected to gastric surgery. Results: Basal CCK concentrations i n the operated group were found to be lower, but increased postprandially t o the same level as in controls. Serum levels of specific pancreatic enzyme s were equal in the 2 groups. Conclusion: It is possible that a disturbed r egulation of pancreatic secretion, or a secretory dysfunction within the gl and, following partial gastrectomy, could contribute to the development of pancreatic carcinoma. However, our findings do not favor the idea of plasma CCK as a promotor of pancreatic carcinoma.