Ann Surg Treat Res.  2022 Jan;102(1):20-28. 10.4174/astr.2022.102.1.20.

Risk factors deteriorating severe exocrine pancreatic insufficiency measured by stool elastase after pancreatoduodenectomy and the risk factors for weight loss

• Cho A
• Kim H
• Sohn HJ
• Lee M
• Kang YH
• Kim HS
• Han Y
• Kang JS
• Kwon W
• Jang JY

• KMID: 2523766
• DOI: http://doi.org/10.4174/astr.2022.102.1.20

Abstract

Purpose
The measurement of stool elastase (SE) level is useful for evaluating pancreatic exocrine function. This study aimed to determine the risk factors for severe exocrine pancreatic insufficiency (EPI) after pancreatoduodenectomy (PD), and analyze serial changes in nutritional markers and weight based on the SE level.
Methods
Among patients who underwent PD for periampullary disease, patients whose preoperative and postoperative SE levels were measured were included in the study. The deteriorated (exocrine function) group comprised patients whose SE levels decreased from ≥100 µg/g preoperatively to <100 µg/g postoperatively. Patients whose weight 12 months postoperatively was greater than that 3 months postoperatively were classified into the weight-recovery group.
Results
Of the 202 included patients, the deteriorated group had a higher incidence of preoperative SE level above 200 μg/ g, benign pathology, and the presence of a clinically relevant postoperative pancreatic fistula than the maintained group. Patients who did not undergo weight recovery had a higher rate of history of adjuvant radiotherapy compared to the norecovery group.
Conclusion
The evaluation of EPI by measuring SE alone is not sufficient because it does not reflect the nutritional status of patients, and a comprehensive approach that considers other parameters is required for EPI management.

Keyword

Exocrine pancreatic insufficiency; Pancreatoduodenectomy; Risk factors; Stool elastase; Weight loss

Figure

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  Fig. 1 Patient selection. Among 544 patients who underwent pancreatoduodenectomy (PD) due to periampullary disease, 274 and 68 patients in whom preoperative and postoperative stool elastase (SE), respectively, were not checked were excluded. Finally, 202 patients were enrolled. Deteriorated group included 135 patients and the maintained group included 67 patients.

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  Fig. 2 Comparison of weight change between the deteriorated group and maintained group. The postoperative weight was serially compared with the preoperative weight, and the subtracted values are compared between the deteriorated and the maintained group.

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  Fig. 3 Comparison of nutritional parameters between the deteriorated group and maintained group. Nutritional parameters such as (A) serum total protein, (B) serum albumin, (C) serum prealbumin, and (D) serum transferrin levels were serially measured preoperatively, 7 days postoperatively, and 6 and 12 months postoperatively and compared between the deteriorated and the maintained groups.

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