Gastrectomy reduces pancreatic secretory function via pancreatic atrophy

Abstract

Purpose Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy. Methods The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy. Results After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019). Conclusions The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy.

Nutritional problems of patients after gastrectomy and the risk of developing malnutrition

“…Altered bile acid flow and pancreatic insufficiency due to disturbances in hormonal regulation of gastrointestinal secretory function, lack of synchronization between food intake and pancreatic secretion, and rapid intestinal transit can lead to steatorrhea [4]. Significant reduction in exocrine pancreatic activity and continuous decrease in pancreatic volume over five years post-operation were observed after total gastrectomy [21]. Pancreatic insufficiency is one of the causes of malabsorption.…”