Aggressive Intervention of Pancrelipase After Pancreatectomy Prevents Deterioration of Postoperative Nutritional Status

Abstract

ObjectivesThis study aimed to investigate the effect of early administration of delayed-release high-titer pancrelipase.MethodsThe medical records of 120 patients who had undergone pancreatectomy with computed tomography (CT) before and 6 months after surgery were retrospectively reviewed. Delayed-release high-titer pancrelipase were administered daily starting on postoperative day 3, which was defined as the EP group. The postoperative nutritional status and CT attenuation values of the liver were compared between the EP and control groups.ResultsThirty-three patients (28%) were categorized into the EP group. With regard to the postoperative nutritional status 6 months after surgery, the body mass index, total lymphocyte count, and Onodera’s prognostic nutritional index were higher, and controlling nutritional status score was lower in the EP group than that in the control group. The CT attenuation values of the liver were not significantly different. After propensity score matching analysis, body mass index (20.7 vs 19.2, P = 0.049) and Onodera’s prognostic nutritional index (47.9 vs 44.2, P = 0.045) were significantly higher, and controlling nutritional status score was significantly lower in the EP group than that in the control group (1 vs 3, P = 0.046).ConclusionsThe early administration of pancrelipase after pancreatectomy improved nutritional status after pancreatectomy.

Development of de novo nonalcoholic fatty liver disease following pancreatectomy

“…[ 3 , 5 , 9 , 19 , 26 , 27 ] In fact, high-dosage PERT was shown to improve BMI and albumin levels, [ 9 ] which attracted researchers to investigate the role of prophylactic PERT in mitigating de novo NAFLD. [ 27 , 28 ] Recent work by Maehira H and colleagues, showed that prophylactic administration of PERT may improve surrogate nutritional markers including BMI and Onodera prognostic nutritional index when compared to controls after pancreatectomy. [ 28 ] Notably, there was no difference in the prevalence of post-operative NAFLD between the 2 groups, which may be attributed to the shorter duration of follow up of 6 months, compared to our study that showed development of NAFLD 2 years post-operatively.…”

“…[ 27 , 28 ] Recent work by Maehira H and colleagues, showed that prophylactic administration of PERT may improve surrogate nutritional markers including BMI and Onodera prognostic nutritional index when compared to controls after pancreatectomy. [ 28 ] Notably, there was no difference in the prevalence of post-operative NAFLD between the 2 groups, which may be attributed to the shorter duration of follow up of 6 months, compared to our study that showed development of NAFLD 2 years post-operatively. [ 28 ] Sato et al proposed a risk score calculator of de novo NAFLD utilizing long operative time, small pancreatic volume, high AST/ALT ratio, high BMI to risk-stratify patients as “low-risk” and “high-risk.” [ 27 ] This work suggested that patients who were deemed “high-risk” could be started on prophylactic PERT.…”

Efficacy of Standardized Process Management of Early Postoperative Enteral Nutrition After Laparoscopic Hepatectomy: A Randomized Controlled Trial

“…Earlier studies have mentioned that good nutritional status can effectively improve the prognosis of surgical patients. 14 Nutrition risk screening is the first step of clinical nutrition support, aiming to screen existing or potential factors related to nutrition that may affect the prognosis of patients. And nutrition support can effectively improve the prognosis.…”

“…In addition, postoperative tissue healing and postoperative fasting require good nutritional status of patients. Earlier studies have mentioned that good nutritional status can effectively improve the prognosis of surgical patients 14 . Nutrition risk screening is the first step of clinical nutrition support, aiming to screen existing or potential factors related to nutrition that may affect the prognosis of patients.…”