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Pancreatic Dysfunction and Reduction in Quality of Life Is Common After Pancreaticoduodenectomy

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Abstract

Background

Improvements in survival after pancreaticoduodenectomy has increased the number of patients potentially at risk of pancreatic insufficiency.

Aims

We studied long-term (> 1 year) pancreatic functions (endocrine and exocrine) after pancreaticoduodenectomy and aimed to recognize the impact of various clinicopathological factors and postoperative complications on pancreatic functions.

Methods

All patients who underwent pancreaticoduodenectomy at least 1 year prior were recruited from July 2020 to December 2021. Endocrine function was assessed using HbA1c, fasting blood sugar and postprandial blood sugar levels. Pancreatic exocrine function was assessed clinically with history of steatorrhea and objectively with quantitative estimation of fecal elastase-1 levels in stool samples. Volume of remnant pancreas, parenchymal thickness and duct diameter were assessed by computed tomography. Quality of life assessment was done using SF-36 questionnaire.

Results

Of the 106 patients assessed, 64 patients met the inclusion criteria. Endocrine insufficiency was noted in 51.6%, and 34.3% had new onset diabetes mellitus. The incidence of pancreatic exocrine insufficiency was 87.5% and severe insufficiency was found in 62.5% of patients. Twenty-nine (45.3%) patients had both exocrine and endocrine insufficiency. Patients with CRPOPF had higher risk of severe exocrine insufficiency (5 vs. 2, OR 1.57(0.28–8.81) p = 0.6). The SF-36 scores were lower than general population especially in role limitation due to physical health, role limitation due to emotional problems, energy/fatigue, general health perception and health change domains.

Conclusion

Post-pancreaticoduodenectomy patients have a high frequency of pancreatic insufficiency and should be screened for same. The post-operative pancreatic fistula increases the risk of pancreatic exocrine insufficiency.

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Authors and Affiliations

  1. Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Shradha Kanwat

  2. Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Harjeet Singh, Vikas Gupta, Thakur Deen Yadav & Rajesh Gupta

  3. Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Arun Kumar Sharma & Vishal Sharma

  4. Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India

    Pankaj Gupta

  5. Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER), F-block, Nehru Hospital, Sector 12, Chandigarh, India

    Harjeet Singh

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  1. Shradha Kanwat
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Kanwat, S., Singh, H., Sharma, A.K. et al. Pancreatic Dysfunction and Reduction in Quality of Life Is Common After Pancreaticoduodenectomy. Dig Dis Sci 68, 3167–3173 (2023). https://doi.org/10.1007/s10620-023-07966-6

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