Pancreaticoduodenectomy for Peri-Ampullary Neoplasia Leads to Specific Micronutrient Deficiencies

Armstrong, Tom; Strömmer, Lisa; Ruiz-Jasbon, F.; Shek, Fanny; Harris, Scott; Permert, Johan; Johnson, C. D.

doi:10.1159/000101876

Cited by 47 publications

(40 citation statements)

References 17 publications

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“…Some studies have reported that the PD patients had adequate energy intake 16 and similar to patients who underwent subtotal gastrectomy 12 , cholecystectomy 13 or healthy controls 17 . Our results can be attributed to good adherence to dietary guidelines but it is possible…”

Section: Discussionmentioning

confidence: 93%

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

Muniz¹,

Braga²,

Kemp³

et al. 2012

Acta Cir. Bras.

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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.

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Section: Discussionmentioning

confidence: 93%

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

Muniz¹,

Braga²,

Kemp³

et al. 2012

Acta Cir. Bras.

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“…Post-PD patients have been reported to have vitamin A, iron, zinc, and selenium deficiencies [3,4], but this is the first report in English literature of vitamin B6 deficiency. Vitamin B6 deficiency is rarely seen in healthy individuals [1,5], but malabsorption can occur in post-PD patients because vitamin B6 is absorbed in the proximal small bowel [1].…”

Section: Discussionmentioning

confidence: 83%

Anemia attributed to vitamin B6 deficiency in post-pancreaticoduodenectomy patients

et al. 2015

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“…Also, the patients had have low levels of antioxidants: selenium (0.78 vs. 0.93 micromol/L, p < 0.0001) and vitamin E (a 27.4 vs. 35.7 micromol/L, p= 0,0017) with 57% patients having with high deficiencies of selenium. Moreover, patients had lower values of vitamin D versus controls (16.3 vs. 19.6 micromoles/L, p= 0,034), and 30% of the patients had increased levels of parathyroid hormone, suggesting compensatory mechanisms that are functioning in the resected patients in order to maintain normal blood calcium values, which seems to be a consequence of malabsorption [5].…”

Section: Iron Selenium Vitamin D and Vitamin Ementioning

confidence: 96%

“…37 patients who underwent duodenopancreatectomy for periampullary tumors and 25 healthy subjects were included in the study. All subjects received alimentary intake in accordance with the established diet and BMI was measured [5]. It was showed that patients had elevated transferrin levels (median value 2.58 vs. 2.16 g/L, p= 0.0143) and low levels of ferritin (37.7 vs. 119.0 g/L, p < 0.0001), which of course indicated iron deficiency, as compared to the control group of healthy subjects.…”

Section: Iron Selenium Vitamin D and Vitamin Ementioning

confidence: 99%

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Studying the Post-Operatory and Molecular Modifications in the Chronic Pancreatitis and Pancreatic Cancer - The Importance of the Micronutrients and Pancreatic Enzyme Supplementation

Timofte

Bințințan²,

Munteanu

et al. 2015

ILNS

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ABSTRACT.The pancreatic cancer is a disorder with an exponentially increased incidence, especially over the last few years. Moreover, it is estimated that almost 95% of the patients with this disease are presenting to the hospital in the advanced and unresectable stages. Also, over the past few decades the development and advance of the surgical methods and techniques have improved, with the most of the operatory actions in the chronic pancreatitis and pancreatic cancer being represented by the whipple duodeno-pancreatectomy, which in fact represents the standard resection for tumors of the duodenum, as well as the hepatopancreatic ampulla of Vater, distal choledocus and the head of the pancreas. Moreover, it is important to mention that in these cases, after an extended resection and reconstruction of the upper gastrointestinal tract, the digestive physiology will be disrupted. In addition, previous studies have shown that patients can maintain a body mass index after surgery but often this will be lower than its preoperative value. Thus, considering the aforementioned aspects, in the present mini-review we were mainly interested in presenting also the relevance of the micronutrients such as iron, selenium, vitamin D and E, zinc or copper in this complicated area of research, as well as aspects regarding the correlations between immune function and micronutrients or the pancreatic enzyme supplementation.

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Pancreaticoduodenectomy for Peri-Ampullary Neoplasia Leads to Specific Micronutrient Deficiencies

Cited by 47 publications

References 17 publications

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

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

Anemia attributed to vitamin B6 deficiency in post-pancreaticoduodenectomy patients

Studying the Post-Operatory and Molecular Modifications in the Chronic Pancreatitis and Pancreatic Cancer - The Importance of the Micronutrients and Pancreatic Enzyme Supplementation

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