Skip to main content

Advertisement

SpringerLink
Log in

Pancreatic atrophy after gastrectomy for gastric cancer

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

To investigate the phenomenon of pancreatic atrophy after gastrectomy for gastric cancer, using computed tomography (CT) volumetry.

Methods

The subjects of this retrospective study were 77 patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for pStage I gastric cancer in 2014. The relative pancreatic volume ratio was assessed preoperatively, and then 1 and 5 years postoperatively and the results were compared between surgical procedures

Results

A total of 14 patients underwent TG with Roux-en-Y (RY) reconstruction, 24 underwent DG with Billroth-I (BI) reconstruction, and 39 underwent DG with RY reconstruction. We observed that the pancreatic volume continued to decrease over the 5 years after DG or TG. Furthermore, the incidence of pancreatic atrophy 5 years postoperatively was significantly greater after TG than after DG. In patients who underwent DG, a greater incidence of pancreatic atrophy was observed after RY reconstruction than after BI reconstruction, 5 years postoperatively.

Conclusion

The pancreatic volume continued to decrease after DG and TG for gastric cancer 5 years after treatment. TG was associated with a significantly greater incidence of pancreatic atrophy than DG 5 years postoperatively, as was RY reconstruction vs. BI reconstruction after DG.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Pineros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144:1941–53.

    Article  CAS  Google Scholar 

  2. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2020. https://doi.org/10.1007/s10120-020-01042-y.

    Article  PubMed Central  Google Scholar 

  3. Liedman B. Symptoms after total gastrectomy on food intake, body composition, bone metabolism, and quality of life in gastric cancer patients–is reconstruction with a reservoir worthwhile? Nutrition. 1999;15:677–82.

    Article  CAS  Google Scholar 

  4. Hillman HS. Postgastrectomy malnutrition. Gut. 1968;9:576–84.

    Article  CAS  Google Scholar 

  5. Fieker A, Philpott J, Armand M. Enzyme replacement therapy for pancreatic insufficiency: present and future. Clin Exp Gastroenterol. 2011;4:55–73.

    PubMed  PubMed Central  Google Scholar 

  6. Antonini F, Crippa S, Falconi M, Macarri G, Pezzilli R. Pancreatic enzyme replacement therapy after gastric resection: an update. Dig Liver Dis. 2018;50:1–5.

    Article  CAS  Google Scholar 

  7. Straatman J, Wiegel J, van der Wielen N, Jansma EP, Cuesta MA, van der Peet DL. Systematic review of exocrine pancreatic insufficiency after gastrectomy for cancer. Dig Surg. 2017;34:364–70.

    Article  CAS  Google Scholar 

  8. Geraghty EM, Boone JM, McGahan JP, Jain K. Normal organ volume assessment from abdominal CT. Abdom Imaging. 2004;29:482–90.

    Article  CAS  Google Scholar 

  9. Szczepaniak EW, Malliaras K, Nelson MD, Szczepaniak LS. Measurement of pancreatic volume by abdominal MRI: a validation study. PLoS ONE. 2013;8:e55991.

    Article  CAS  Google Scholar 

  10. Williams AJ, Chau W, Callaway MP, Dayan CM. Magnetic resonance imaging: a reliable method for measuring pancreatic volume in Type 1 diabetes. Diabet Med. 2007;24:35–40.

    Article  CAS  Google Scholar 

  11. Schrader H, Menge BA, Schneider S, Belyaev O, Tannapfel A, Uhl W, et al. Reduced pancreatic volume and beta-cell area in patients with chronic pancreatitis. Gastroenterology. 2009;136:513–22.

    Article  Google Scholar 

  12. Campbell-Thompson M, Rodriguez-Calvo T, Battaglia M. Abnormalities of the exocrine pancreas in Type 1 diabetes. Curr Diabetes Rep. 2015;15:79.

    Article  Google Scholar 

  13. Kleeff J, Whitcomb DC, Shimosegawa T, Esposito I, Lerch MM, Gress T, et al. Chronic pancreatitis. Nat Rev Dis Primers. 2017;3:17060.

    Article  Google Scholar 

  14. Lu J, Guo M, Wang H, Pan H, Wang L, Yu X, et al. Association between pancreatic atrophy and loss of insulin secretory capacity in patients with Type 2 diabetes mellitus. J Diabetes Res. 2019;2019:6371231.

    PubMed  PubMed Central  Google Scholar 

  15. Hashimoto N, Yasuda T, Haji S, Nomura H, Ohyanagi H. Comparison of the functional and morphological changes in the pancreatic remnant between pylorus-preserving pancreatoduodenectomy and pancreatoduodenectomy. Hepatogastroenterology. 2003;50:2229–32.

    PubMed  Google Scholar 

  16. Kim JH, Yoo BM, Kim JH, Kim WH. Which method should we select for pancreatic anastomosis after pancreaticoduodenectomy? World J Surg. 2009;33:326–32.

    Article  CAS  Google Scholar 

  17. Tomimaru Y, Takeda Y, Kobayashi S, Marubashi S, Lee CM, Tanemura M, et al. Comparison of postoperative morphological changes in remnant pancreas between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. Pancreas. 2009;38:203–7.

    Article  Google Scholar 

  18. Klupp F, Klauss M, Rahbari NN, Felix K, Hinz U, Manglberger I, et al. Volume changes of the pancreatic head remnant after distal pancreatectomy. Surgery. 2020;167:455–67.

    Article  Google Scholar 

  19. Takahashi K, Sasaki R, Kondo T, Oda T, Murata S, Ohkohchi N. Preoperative 3D volumetric analysis for liver congestion applied in a patient with hilar cholangiocarcinoma. Langenbecks Arch Surg. 2010;395:761–5.

    Article  Google Scholar 

  20. Mise Y, Tani K, Aoki T, Sakamoto Y, Hasegawa K, Sugawara Y, et al. Virtual liver resection: computer-assisted operation planning using a three-dimensional liver representation. J Hepatobiliary Pancreat Sci. 2013;20:157–64.

    Article  Google Scholar 

  21. Nakayama K, Oshiro Y, Miyamoto R, Kohno K, Fukunaga K, Ohkohchi N. The effect of three-dimensional preoperative simulation on liver surgery. World J Surg. 2017;41:1840–7.

    Article  Google Scholar 

  22. Miyamoto R, Oshiro Y, Sano N, Inagawa S, Ohkohchi N. Three-Dimensional remnant pancreatic volumetry predicts postoperative pancreatic fistula in pancreatic cancer patients after pancreaticoduodenectomy. Gastrointest Tumors. 2019;5:90–9.

    Article  Google Scholar 

  23. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  24. Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transpl. 2013;48:452–8.

    Article  CAS  Google Scholar 

  25. Dominguez-Munoz JE. Pancreatic enzyme replacement therapy: exocrine pancreatic insufficiency after gastrointestinal surgery. HPB (Oxford). 2009;11(Suppl 3):3–6.

    Article  Google Scholar 

  26. Saisho Y, Butler AE, Meier JJ, Monchamp T, Allen-Auerbach M, Rizza RA, et al. Pancreas volumes in humans from birth to age one hundred taking into account sex, obesity, and presence of type-2 diabetes. Clin Anat. 2007;20:933–42.

    Article  CAS  Google Scholar 

  27. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60.

    Article  CAS  Google Scholar 

  28. Masuda Y, Tanaka T, Inomata N, Ohnuma N, Tanaka S, Itoh Z, et al. Ghrelin stimulates gastric acid secretion and motility in rats. Biochem Biophys Res Commun. 2000;276:905–8.

    Article  CAS  Google Scholar 

  29. Shintani M, Ogawa Y, Ebihara K, Aizawa-Abe M, Miyanaga F, Takaya K, et al. Ghrelin, an endogenous growth hormone secretagogue, is a novel orexigenic peptide that antagonizes leptin action through the activation of hypothalamic neuropeptide Y/Y1 receptor pathway. Diabetes. 2001;50:227–32.

    Article  CAS  Google Scholar 

  30. Adachi S, Takiguchi S, Okada K, Yamamoto K, Yamasaki M, Miyata H, et al. Effects of ghrelin administration after total gastrectomy: a prospective, randomized, placebo-controlled phase II study. Gastroenterology. 2010;138:1312–20.

    Article  CAS  Google Scholar 

  31. Pandol SJ. Colloquium series on integrated systems physiology: from molecule to function to disease. Exocrine Pancreas. 2010;3:1–64.

    Google Scholar 

  32. Whitcomb DC, Frulloni L, Garg P, Greer JB, Schneider A, Yadav D, et al. Chronic pancreatitis: an international draft consensus proposal for a new mechanistic definition. Pancreatology. 2016;16:218–24.

    Article  Google Scholar 

  33. Armbrecht U, Lundell L, Stockbruegger RW. Nutrient malassimilation after total gastrectomy and possible intervention. Digestion. 1987;37(Suppl 1):56–60.

    Article  Google Scholar 

  34. Armbrecht U, Lundell L, Stockbrugger RW. The benefit of pancreatic enzyme substitution after total gastrectomy. Aliment Pharmacol Ther. 1988;2:493–500.

    Article  CAS  Google Scholar 

  35. Bragelmann R, Armbrecht U, Rosemeyer D, Schneider B, Zilly W, Stockbrugger RW. The effect of pancreatic enzyme supplementation in patients with steatorrhoea after total gastrectomy. Eur J Gastroenterol Hepatol. 1999;11:231–7.

    Article  CAS  Google Scholar 

  36. Catarci M, Berlanda M, Grassi GB, Masedu F, Guadagni S. Pancreatic enzyme supplementation after gastrectomy for gastric cancer: a randomized controlled trial. Gastric Cancer. 2018;21:542–51.

    Article  CAS  Google Scholar 

  37. Pezzilli R, Andriulli A, Bassi C, Balzano G, Cantore M, Delle Fave G, et al. Exocrine pancreatic insufficiency in adults: a shared position statement of the Italian Association for the Study of the Pancreas. World J Gastroenterol. 2013;19:7930–46.

    Article  Google Scholar 

  38. Vujasinovic M, Valente R, Thorell A, Rutkowski W, Haas SL, Arnelo U, et al. Pancreatic exocrine insufficiency after bariatric surgery. Nutrients. 2017;9:1241.

    Article  Google Scholar 

Download references

Funding

We have no financial relationships to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Ryo Takahashi, Souya Nunobe, Naohito Sai, Rie Makuuchi, Satoshi Ida, Koshi Kumagai, Manabu Ohashi & Takeshi Sano

  2. Department of General Surgery, Hekinan Municipal Hospital, Aichi, Japan

    Ryo Takahashi

Authors
  1. Ryo Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Souya Nunobe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naohito Sai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rie Makuuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Satoshi Ida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Koshi Kumagai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Manabu Ohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takeshi Sano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Souya Nunobe.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

The Institutional Review Boards approved this study (2019-1226).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

595_2020_2131_MOESM1_ESM.docx

Supplementary file1 Supplementary Fig. 1 Comparison of relative bodyweight ratio between patients who underwent distal gastrectomy vs. those who underwent total gastrectomy. DG distal gastrectomy, TG total gastrectomy, POY postoperative year. Supplementary Fig. 2 Comparison of serum levels of total protein (a), albumin (b), and prealbumin (c) between patients who underwent distal gastrectomy vs. those who underwent total gastrectomy. DG distal gastrectomy, TG total gastrectomy, Pre preoperation, POY postoperative year. Supplementary Fig. 3 Comparison of relative bodyweight ratio between patients who underwent Bilroth-I vs. those who underwent Roux-en-Y reconstruction after distal gastrectomy. BI Billroth-I, RY Roux-en-Y, POY postoperative year. Supplementary Fig. 4 Comparison of serum levels of total protein (a), albumin (b), and prealbumin (c) between patients who underwent Bilroth-I vs. those who underwent Roux-en-Y reconstruction after distal gastrectomy. BI Billroth-I, RY Roux-en-Y, Pre preoperation, POY postoperative year (DOCX 169 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takahashi, R., Nunobe, S., Sai, N. et al. Pancreatic atrophy after gastrectomy for gastric cancer. Surg Today 51, 432–438 (2021). https://doi.org/10.1007/s00595-020-02131-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02131-2

Keywords

Search

Navigation