Long-term results of duodenopancreatectomy

Abstract

Introduction: Duodenopancreatectomy (DP) is a common procedure for neoplasms of the pancreaticoduodenal region, however, exocrine pancreatic insufficiency (EPI) and associated nutritional disorders remain poorly understood. Current data on the incidence and severity of these abnormalities are conflicting, which complicates the optimization of pancreatic enzyme replacement therapy (PERT) in the postoperative period.
Objective: To determine the incidence of EPI and nutritional status disorders in patients who have undergone DP for benign and malignant neoplasms.
Materials and Methods: A total of 102 patients aged 22 to 82 years (mean age 61.1±14.5 years, median 63 years) who underwent DP were examined. Of these, 69 patients (67.6%) were operated on for malignant neoplasms, and 33 (32.3%) for benign neoplasms. Levels of fecal pancreatic elastase and nutritional parameters were assessed, including hemoglobin, absolute lymphocyte count, albumin, prealbumin, and retinol-binding protein.
Results: Analysis of exocrine pancreatic function at 12 or more months after DP, based on fecal elastase levels, revealed that following resections for malignant neoplasms, 60 patients (87%) developed severe exocrine insufficiency, 6 (8.7%) moderate insufficiency, and 3 (4.3%) mild insufficiency. After DP for benign neoplasms, severe exocrine insufficiency was found in 26 patients (79%), moderate in 4 (12%), and no exocrine dysfunction was detected in 3 (9%) (p<0.05). Patients in both groups received pancreatic enzyme replacement therapy at a dose of 150,000 to 200,000 units of lipase per day. No nutritional status abnormalities were observed based on the parameters assessed. Mean values of nutritional parameters in both patient groups are presented in Table 1.
Conclusion: Analysis of the obtained results revealed no association between the type of neoplasm and the level of fecal pancreatic elastase after resection. Malignant neoplasms were a predictor of more pronounced exocrine dysfunction in operated patients; however, the difference was not statistically significant. Nutritional parameters remained within reference ranges, indicating adequate PERT. A small number of patients operated on for benign neoplasms had no exocrine dysfunction and did not require high doses of PERT. Further studies are needed to obtain more precise data.