Abstract
Background and purpose
The present study was done to investigate the prevalence of zinc deficiency after pancreatoduodenectomy (PD) and its correlation with pancreatic exocrine insufficiency.
Materials and methods
Patients were included in this study if they had undergone PD for periampullary tumors without recurrence and had received follow-up for more than 6 months between February 2006 and June 2007. Serum levels of zinc, fasting glucose, albumin, and iron were obtained. The pancreatic exocrine function was evaluated by a fecal elastase-1 assay, stool fat assessment, and a pancreatic duct-parenchymal ratio (DPR) at the L1 level using abdominal computed tomography (CT). The quality of life was estimated with a questionnaire of EORTC QLQ-C30 and PAN26. All of these patients were then supplemented with oral pancreatic enzymes for 4 weeks to evaluate the effect of these enzymes on zinc deficiency.
Results
Forty-eight eligible patients, 27 men and 21 women, were included. The mean age was 61.3 ± 1.7 years. Thirty-three (68%) patients had a zinc deficiency with a mean zinc level of 72.3 ± 2.9 mcg/dl (normal range: 80–120 mcg/dl). Patients with lower serum zinc levels tended to have typical presentations of zinc deficiency (P = 0.039, χ2). The serum zinc level was significantly negatively correlated with pancreatic duct diameter, DPR, and positive stool fat during the late follow-up period. The most common presentations of patients with lower serum zinc levels were skin rash, photophobia, and glossitis. These gastrointestinal disorders, as well as symptoms of zinc deficiency, improved after pancreatic enzyme supplementation.
Conclusions
Zinc deficiency after PD was a common phenomenon and correlated with pancreatic exocrine insufficiency.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Whipple AO, Parsons WB, Mullins CR (1935) Treatment of carcinoma of the ampulla of Vater. Ann Surg 102:763–779
Mochiki E, Asao T, Kuwano H (2007) Gastrointestinal motility after digestive surgery. Surg Today 37:1023–1032
Cameron JL (2000) Whipple or pylorus preservation? A critical reappraisal and some new insights into pancreaticoduodenectomy. Ann Surg 231:301–302
Armstrong T, Walters E, Varshney S et al (2002) Deficiencies of micronutrients, altered bowel function, and quality of life during late follow-up after pancreaticoduodenectomy for malignancy. Pancreatology 2:528–534
Yu HH, Shan YS, Lin PW (2007) Zinc deficiency with acrodermatitis enteropathica-like eruption after pancreaticoduodenectomy. J Formos Med Assoc 106:864–868
Kita T, Nakamura K, Kida H et al (1988) Pathophysiology during follow-up after extensive pancreatectomy. Nippon Geka Gakkai Zasshi 89:1426–1429
Sato N, Yamaguchi K, Chijiiwa K et al (1998) Duct-parenchymal ratio predicts exocrine pancreatic function after pancreatoduodenectomy and distal pancreatectomy. Am J Surg 176:270–273
King JC, Keen CL (1999) Modern nutrition in health and disease, 9th edn. Baltimore, Williams and Wilkins, pp 223–239
Salgueiro MJ, Boccio JR, Zubillaga MB et al (2000) Zinc as an essential micronutrient: a review. Nutr Res 20:735–737
Fraker P, King L (1998) Changes in regulation of lyphopoiesis and mielopoiesis in the zinc-deficient mouse. Nutr Rev 56:65s–69s
Kim YJ, Kim MY, Kim HO et al (2005) Acrodermatitis enteropathica-like eruption associated with combined nutritional deficiency. J Korean Med Sci 20:908–911
Wapnir RA (2000) Zinc deficiency, malnutrition and the gastrointestinal tract. J Nutr 130:1388S–1392S
Hambidge M (2000) Human zinc deficiency. J Nutr 130:1344S–1349S
Huang JJ, Yeo CJ, Sohn TA et al (2000) Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg 231:890–898
Prasad AS (2003) Zinc deficiency. BMJ 326:409–410
Griffin IJ, Kim SC, Hicks PD et al (2004) Zinc metabolism in adolescents with Crohn’s disease. Pediatr Res 56:235–239
McLeod RS, Taylor BR, O’Connor BI et al (1995) Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure. Am J Surg 169:179–185
Jaffe AT, Heymann WR (1998) Kwashiorkor/zinc deficiency overlap following partial gastrectomy. Int J Dermatol 37:134–137
Dutta SK, Procaccino F, Aamodt R (1998) Zinc metabolism in patients with exocrine pancreatic insufficiency. J Am Coll Nutr 17:556–563
Adrian TE, Bloom SR, Bryant MG et al (1976) Distribution and release of human pancreatic polypeptide. Gut 17:940–944
Grendell JH (1983) Nutrition and absorption in diseases of the pancreas. Clin Gastroenterol 12:551–562
Caulfield LE, Black RE (2004) Zinc deficiency. In: Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors, vol 1. World Health Organisation, Geneva, pp. 257–279
Krebs NF (2000) Overview of zinc absorption and excretion in the human gastrointestinal tract. J Nutr 130:1374S–1377S
Krieger J, Evan GW (1980) Acrodermatitis enteropathica without hypozincemia: therapeutic effect of a pancreatic enzyme preparation due to zinc binding ligand. J Pediatr 96:32–35
Author information
Authors and Affiliations
Corresponding author
Additional information
Hsin-Hsien Yu and Ta-Ming Yang contributed equally to this work.
Rights and permissions
About this article
Cite this article
Yu, HH., Yang, TM., Shan, YS. et al. Zinc Deficiency in Patients Undergoing Pancreatoduodenectomy for Periampullary Tumors Is Associated with Pancreatic Exocrine Insufficiency. World J Surg 35, 2110–2117 (2011). https://doi.org/10.1007/s00268-011-1170-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1170-z