Analysis of multiple factors of postsurgical gastroparesis syndrome after pancreaticoduodenectomy and cryotherapy for pancreatic cancer

Abstract

AIM:To explore the etiology, pathogenesis, diagnosis, and treatment of postsurgical gastroparesis syndrome (PGS) after pancreatic cancer cryotherapy (PCC) or pancreaticoduodenectomy (PD), and to analyze the correlation between the multiple factors and PGS caused by the operations. METHODS:Clinical data of 210 patients undergoing PD and 46 undergoing PCC were analyzed retrospectively. RESULTS:There were 31 (67%, 31/46) patients suffering PGS in PCC group, including 29 with pancreatic head and uncinate tumors and 2 with pancreatic body and tail tumors. Ten patients (4.8%, 10/210) developed PGS in PD group, which had a significantly lower incidence of PGS than PCC group (χ = 145, P<0.001). In PCC group, 9 patients with PGS were managed with non-operative treatment (drugs, diet, nasogastric suction, etc.), and one received reoperation at the 16th day, but the symptoms were not relieved. In PD group, all the patients with PGS were managed with non-operative treatment. The PGS in patients undergoing PCC had close association with PCC, tumor location, but not with age, gender, obstructive jaundice, hypoproteinemia, preoperative gastric outlet obstruction and the type and number of gastric biliary tract operations. The mechanisms of PGS caused by PD were similar to those of PGS following gastrectomy. The damage to interstitial cells of Cajal might play a role in the pathogenesis of PGS after PCC, for which multiple factors were possibly responsible, including ischemic and neural injury to the antropyloric muscle and the duodenum after freezing of the pancreatico-duodenal regions or reduced circulating levels of motilin.CONCLUSION: PGS after PCC or PD is induced by multiple factors and the exact mechanisms, which might differ between these two operations, remain unknown. Radiography of the upper gastrointestinal tract and gastroscopy are main diagnostic modalities for PGS. Non-operative treatments are effective for PGS, and reoperation should be avoided in patients with PGS caused by PCC. Dong K, Li B, Guan QL, Huang T. Analysis of multiple factors of postsurgical gastroparesis syndrome after pancreaticoduodenectomy and cryotherapy for pancreatic cancer.

Evidenz für Kryotherapie bei Verletzungen und Erkrankungen des Bewegungsapparates

“…Zur Anwendung in der Hüft-und Knie-Endoprothetik liegen widersprüch-liche Ergebnisse vor [3,21]. In der Kreuzband-und Meniskuschirurgie [14,12,31,53], bei Gonarthrose [9], bei rheumatoider Arthritis [39] und bei chronischem Schmerz [37] ist die Kryotherapie in Bezug auf Schmerz unwirksam.…”

“…Allerdings wird der Kryotherapie eine Resorption fördernde Wirkung bei der Gonarthrose zugesprochen [9]. Eine Verminderung des postoperativen Blutverlustes wurde nur beim künstlichen Gelenkersatz am Knie [21], nicht aber beim Kreuzbandersatz [14] nachgewiesen.…”

“…Die Literatur weist ein breites Anwendungsgebiet für die Kryotherapie aus: In der Onkologie wird der Einsatz bei Lebertumoren [27], Prostata- [43], Bronchial- [32], Pankreas- [14], Zervix- [32] und Basalkarzinom der Haut [5] sowie Hämangiom [48] beschrieben. Für den Bereich der Neurologie finden sich klinische Untersuchungen in Bezug auf die Wirksamkeit der Eistherapie bei den Krankheitsbildern Fazialisneuropathie [35], Epilepsie [26], Multiple Sklerose [19], Apoplex [24] und zur Reduktion der Spastik [4].…”

Results of Completion Gastrectomies in 44 Patients with Postsurgical Gastric Atony

“…Chronic PSGA is thought to be related to vagal nerve injury as well as the anatomic changes resulting from surgery. 2,4 Although patients who develop gastroparesis following truncal vagotomy and drainage may have rapid initial emptying of liquids due to impaired fundic relaxation with loss of reservoir function, they will not empty solids normally due to an absence of the normal lag phase for solids. 4,5,6 The incidence of severe PSGA is probably less than 5% in patients after most operations for peptic ulcer.…”

“…2,4 Although patients who develop gastroparesis following truncal vagotomy and drainage may have rapid initial emptying of liquids due to impaired fundic relaxation with loss of reservoir function, they will not empty solids normally due to an absence of the normal lag phase for solids. 4,5,6 The incidence of severe PSGA is probably less than 5% in patients after most operations for peptic ulcer. 3,7 The incidence is much higher after secondary procedures for postgastrectomy syndromes, such as Roux-en-Y diversion procedures in patients thought to have bile-reflux gastritis.…”