Early and enduring nutritional and functional results of pylorus preservation vs classic Whipple procedure for pancreatic cancer

Niedergethmann, Marco; Shang, E.; Soliman, Michael Farag; Saar, J.; Berisha, S.; Willeke, Frank; Post, Stefan

doi:10.1007/s00423-005-0015-3

Cited by 58 publications

(63 citation statements)

References 43 publications

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“…In the late postoperative period, the appetite and dietary intake are limited by gastrointestinal symptoms like nausea, flatulence, epigastric fullness, vomiting, and diarrhea 8 . In this study, the gastrointestinal symptoms were scarce and seemed not to have interfered with the usual food intake.…”

Section: Discussionmentioning

confidence: 99%

“…showed steatorrhea and needed pancreatic enzymes, while this condition varied from 18 to 73% in several studies 4,5,8,12,13 . In our casuistic, the lower number of patients with pancreatic exocrine insufficiency can be attributed to the efficiency of duct-to-mucosa pancreatojejunal anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…However, the pylorus preservation seems to have advantages in the functional and nutritional status 3,8 . A longitudinal follow-up showed that differences in postoperative weight gain are correlated rather with resection margins and tumor recurrence than with the type of resection 5 .…”

Section: Discussionmentioning

confidence: 99%

“…In recent decades, several studies have been conducted to evaluate clinical and nutritional longterm effects after PD [3][4][5][6][7][8] . However, most studies have not made a complete nutritional assessment and they do not describe digestive complaints or details of food intake patterns.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and nutritional status in the late postoperative of pancreaticoduodenectomy: influence of pylorus preservation procedure

Muniz¹,

Braga²,

Kemp³

et al. 2012

Acta Cir. Bras.

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PURPOSE:To evaluate the nutritional status of patients in the late postoperative period of pancreaticoduodenectomy (PD) and compare the long-term outcome according to pylorus-preserving (PPPD) or the standard technique (SPD) in which the pylorus is resected. METHODS: This prospective study was conducted twelve months prior or more in patients who had underwent PD (PD Group, n=15) and health volunteers (Control Group, n=15). At a post hoc analysis, the PD Group was divided in PPPD Subgroup (n=9) and SPD Subgroup (n=6), according to the PD techniques. Gastrointestinal complaints and nutritional status were evaluated, apart from a biochemical assessment; Student t-test or Mann-Whitney test were used. RESULTS:The patients recovered their body weight and the gastrointestinal complaints were uncommon. The PD Group showed higher energy and protein intake even though BMI was lower than in Control Group. There were no differences in laboratorial data, except for higher glycemia, serum alkaline phosfatase and C-reactive protein in PD Group. There was no difference in the various parameters evaluated when the Subgroups (PPPD and SPD) were compared. CONCLUSION: For long-term pancreaticoduodenectomy, the gastrointestinal symptoms are minimal and the patients had the clinical and nutritional status preserved, regardless of pylorus preservation. Key words: Pancreaticoduodenectomy. Nutritional Status. Anthropometry. Blood Proteins. RESUMO OBJETIVO:Avaliar o estado nutricional de pacientes em pós-operatório tardio de pancreaticoduodenectomia (PD) e comparar a evolução de acordo com a preservação de piloro (PPPD) ou pela técnica padrão com ressecção do piloro (SPD). MÉTODOS: O estudo prospectivo foi conduzido com pacientes submetidos à PD após período mínimo de 12 meses (Grupo PD, n=15) e voluntários saudáveis (Grupo Controle, n=15). Numa análise posterior, o Grupo PD foi dividido em Subgrupo PPPD (n=9) e Subgrupo SPD (n=6), de acordo com a técnica de PD. Foram avaliadas as queixas digestivas, o estado nutricional e dados bioquímicos; a análise estatística foi realizada por meio do teste t-Student ou Mann-Whitney. RESULTADOS: Os pacientes recuperaram o estado nutricional e as queixas gastrointestinais foram incomuns. A ingestão protéica e energética foi maior no Grupo PD, apesar do menor IMC. Não houve diferenças em relação aos exames laboratoriais, exceto pelos maiores níveis de glicemia, fosfatase alcalina sérica e proteína C-reativa no Grupo PD. Quando os Subgrupos PPPD e SPD foram comparados, não houve diferenças nos diversos parâmetros analisados. CONCLUSÃO: No pós-operatório tardio de pancreaticoduodenectomia, os sintomas gastrointestinais são mínimos e o estado clínico e nutricional é adequado, independente da preservação do piloro. Descritores: Pancreaticoduodenectomia. Estado Nutricional. Antropometria. Proteínas Sanguíneas.Muniz CK et al.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical and nutritional status in the late postoperative of pancreaticoduodenectomy: influence of pylorus preservation procedure

Muniz¹,

Braga²,

Kemp³

et al. 2012

Acta Cir. Bras.

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“…Gastric resection is avoided in the pylorus-preserving modification. Mortality and morbidity are not significantly different between both techniques [6] , but the pylorus-preserving procedure improve postoperative weight gain [7][8][9] . The majority of authors consider pancreatic anastomotic leakage as the primary cause of morbidity and mortality after PD [10][11][12][13] .…”

Section: Introductionmentioning

confidence: 98%

Considerations on pancreatic exocrine function after pancreaticoduodenectomy

Morera-Ocón¹,

Sabater-Ortí²,

Muñoz-Forner³

et al. 2014

WJGO

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The pancreaticoduodenectomy (PD) procedure may lead to pancreatic exocrine and endocrine insufficiency. There are several types of reconstruction for this kind of operation. Pancreaticogastrostomy (PG) was introduced to reduce the rate of postoperative pancreatic fistula. Although some randomized control trials have shown no differences regarding pancreatic leakage between PG and pancreaticojejunostomy (PJ), recently some reports reveal benefits from the PG over the PJ. Some surgeons concern about the performing of the PG and inactivation of pancreatic enzymes being in contact with the gastric juice, and the detrimental results over the exocrine pancreatic function. The pancreatic exocrine function can be measured with direct and indirect tests. Direct tests have the highest sensitivity and specificity for detection of exocrine insufficiency but require tube placement. Among the tubeless indirect tests, the van de Kamer stool fat analysis remains the standard to diagnose fat malabsorption. The patient compliance and time consuming makes it not so suitable for its clinical use. Fecal immunoreactive elastase test is employed for screening of exocrine insufficiency, is not cumbersome, and has been used to study pancreatic function after resection. We analyze the FE1 levels in our patients after the PD with two types of reconstruction, PG and PJ, and we discuss some considerations about the pancreaticointestinal drainage method after pancreaticoduodenectomy. Core tip: Many patients present pancreatic exocrine insufficiency after pancreatic resection. Exocrine insufficiency leads to steatorrhoea, flatulence, abdominal pain, weight loss and malnutrition. Extent of resection will determine the severity of insufficiency, but also changes in anatomy may be determining factors. Pancreatogastrostomy is deemed detrimental over the pancreatic function because of the hypothetical inactivation of pancreatic enzymes due to the acid juice of the stomach. In this review we discuss the physiological aspects of the changes in exocrine pancreatic function focusing on the pancreatoenterostomy after a pancreaticoduodenectomy.Morera-Ocon FJ, Sabater-Orti L, Muñoz-Forner E, Pérez-Griera J, Ortega-Serrano J. Considerations on pancreatic exocrine function after pancreaticoduodenectomy. World J Gastrointest Oncol 2014; 6(9): 325-329 Available from:

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Pylorus‐preserving versus Pylorus‐resecting: Impact on dynamic changes of nutrition and body composition in pancreatic cancer patients before and after pancreatoduodenectomy

et al. 2022

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Objectives To investigate if different methods of pancreatoduodenectomy (with or without pyloric preservation) would have different impacts on postoperative nutrition and body composition changes among pancreatic cancer patients. Methods Demographic and clinicopathological data, perioperative data were collected, body composition (e.g. skeletal muscle cross‐sectional area [CSA], visceral fat area [VFA]) were evaluated with abdominal CT before and after surgery. Sarcopenia patients' proportion changes were also recorded. Results The hospital stay in the PRPD group was significantly less than that in the PPPD group ( p < 0.05). A significant difference was found in CSA, skeletal muscle index (SMI), VFA, VFA/CSA and albumin (ALB) in both groups between preoperative, 3, and 12 months after surgery. The loss of visceral fat in the PRPD group was more prominent than that in the PPPD group at 3 months and 12 months after surgery ( p < 0.05). VFA/CSA was higher in the PPPD group than in the PRPD group (3 months: p < 0.05, 12 months: p < 0.001). The proportion of sarcopenic patients increased significantly over time in the PPPD and PRPD groups ( p < 0.001). Conclusions Postoperative CSA and VFA continued to significantly decrease in both PPPD and PRPD groups, while the incidence of sarcopenia continued to increase. Compared with PRPD, PPPD has a protective effect on visceral fat. PPPD may contribute to better maintaining visceral fat mass and blood ALB levels. CT quantification can be an objective and effective method to evaluate the nutritional status of pancreatic cancer patients during the pre‐ and postoperative period and can provide a useful objective basis for guiding clinical treatment.

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Early and enduring nutritional and functional results of pylorus preservation vs classic Whipple procedure for pancreatic cancer

Abstract: Besides favorable postoperative outcome in specific aspects and equal oncological outcome of PPPD, pylorus preservation seems to have advantages in enduring functional and nutritional status years after surgery for pancreatic cancer.

Cited by 58 publications

References 43 publications

Clinical and nutritional status in the late postoperative of pancreaticoduodenectomy: influence of pylorus preservation procedure

Clinical and nutritional status in the late postoperative of pancreaticoduodenectomy: influence of pylorus preservation procedure

Considerations on pancreatic exocrine function after pancreaticoduodenectomy

Pylorus‐preserving versus Pylorus‐resecting: Impact on dynamic changes of nutrition and body composition in pancreatic cancer patients before and after pancreatoduodenectomy

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