Clinical and nutritional status in the late postoperative of pancreaticoduodenectomy: influence of pylorus preservation procedure

Abstract

PURPOSE:To evaluate the nutritional status of patients in the late postoperative period of pancreaticoduodenectomy (PD) and compare the long-term outcome according to pylorus-preserving (PPPD) or the standard technique (SPD) in which the pylorus is resected. METHODS: This prospective study was conducted twelve months prior or more in patients who had underwent PD (PD Group, n=15) and health volunteers (Control Group, n=15). At a post hoc analysis, the PD Group was divided in PPPD Subgroup (n=9) and SPD Subgroup (n=6), according to the PD techniques. Gastrointestinal complaints and nutritional status were evaluated, apart from a biochemical assessment; Student t-test or Mann-Whitney test were used. RESULTS:The patients recovered their body weight and the gastrointestinal complaints were uncommon. The PD Group showed higher energy and protein intake even though BMI was lower than in Control Group. There were no differences in laboratorial data, except for higher glycemia, serum alkaline phosfatase and C-reactive protein in PD Group. There was no difference in the various parameters evaluated when the Subgroups (PPPD and SPD) were compared. CONCLUSION: For long-term pancreaticoduodenectomy, the gastrointestinal symptoms are minimal and the patients had the clinical and nutritional status preserved, regardless of pylorus preservation. Key words: Pancreaticoduodenectomy. Nutritional Status. Anthropometry. Blood Proteins. RESUMO OBJETIVO:Avaliar o estado nutricional de pacientes em pós-operatório tardio de pancreaticoduodenectomia (PD) e comparar a evolução de acordo com a preservação de piloro (PPPD) ou pela técnica padrão com ressecção do piloro (SPD). MÉTODOS: O estudo prospectivo foi conduzido com pacientes submetidos à PD após período mínimo de 12 meses (Grupo PD, n=15) e voluntários saudáveis (Grupo Controle, n=15). Numa análise posterior, o Grupo PD foi dividido em Subgrupo PPPD (n=9) e Subgrupo SPD (n=6), de acordo com a técnica de PD. Foram avaliadas as queixas digestivas, o estado nutricional e dados bioquímicos; a análise estatística foi realizada por meio do teste t-Student ou Mann-Whitney. RESULTADOS: Os pacientes recuperaram o estado nutricional e as queixas gastrointestinais foram incomuns. A ingestão protéica e energética foi maior no Grupo PD, apesar do menor IMC. Não houve diferenças em relação aos exames laboratoriais, exceto pelos maiores níveis de glicemia, fosfatase alcalina sérica e proteína C-reativa no Grupo PD. Quando os Subgrupos PPPD e SPD foram comparados, não houve diferenças nos diversos parâmetros analisados. CONCLUSÃO: No pós-operatório tardio de pancreaticoduodenectomia, os sintomas gastrointestinais são mínimos e o estado clínico e nutricional é adequado, independente da preservação do piloro. Descritores: Pancreaticoduodenectomia. Estado Nutricional. Antropometria. Proteínas Sanguíneas.Muniz CK et al.

A Study on the Dietary Intake and the Nutritional Status among the Pancreatic Cancer Surgical Patients

“…Similar trends were observed in mid-arm circumference, triceps skin fold thickness and hand-grip [13]. Others reported that 90% of the patients who had PD surgery recovered their preoperative body weight by 12 months, whereas 60%–85% of the patients recovered their weight by 6 months [101415]. Previous studies stated that malnutrition and weight loss in PD group significantly affect QoL [16].…”

“…Park et al [9] reported that relative body weight (RBW) and triceps skinfold thickness (TSFT) had significantly decreased after the surgery and recovered to more than 90% of the preoperative value by 12 months whereas transferrin, albumin (Alb) and protein had returned to preoperative levels by 3 months. Muniz et al [10] reported higher levels of glycemia, alkaline phosphatase, and C-reactive protein (CRP) among the PD group in comparison with control group.…”

Nutritional Status, Fecal Elastase-1, and 13C-labeled Mixed Triglyceride Breath Test in the Long-term After Pancreaticoduodenectomy

“…28 Pancreatic exocrine insufficiency was less frequent when pancreas anastomosis was performed in the jejunum (pancreatojejunostomy) rather than in the stomach (pancreatogastrostomy). 28 Pancreatic exocrine insufficiency was less frequent when pancreas anastomosis was performed in the jejunum (pancreatojejunostomy) rather than in the stomach (pancreatogastrostomy).…”

Pancreatic Surgery

“…Studies have reported 7%–15% weight loss in total gastrectomy patients and 7%–10% weight loss in esophagectomy and pancreatectomy patients postoperatively 95 . The GI dysfunction caused by the surgery eventually resolves, and studies have found that 6–12 months after the operation, most PD patients are able to regain weight to their preoperative baseline 28 , 96 . However, it is unclear if getting them back to baseline faster would provide an additional benefit.…”

“…Several studies have looked at QOL measures in postoperative pancreatic surgery. Most report significant weight loss postoperatively (mostly specific to PD), with one study reporting 90% of patients able to regain weight in 1 year, 96 whereas another reported 60%–85% of patients regained weight by 6 months 35 . Another study, including total gastrectomies, reported that patients with malnutrition and percent weight change postoperatively had a decreased QOL and more symptoms 95 .…”