Gastric emptying and quality of life after pancreatoduodenectomy with retrocolic or antecolic gastroenteric anastomosis

Abstract

Background: Delayed gastric emptying (DGE) is a major problem after pancreatoduodenectomy (PD). A recent multicentre randomized trial reported no difference in gastric emptying rates between retrocolic and antecolic reconstruction routes. The present study looked at quality of life with these two approaches and the correlation with gastric emptying. Results: There were 38 patients in the retrocolic and 35 in the antecolic group. Baseline characteristics and clinical outcomes were similar in the two groups. Median time to half-emptying of stomach content after surgery was 145 and 64 min in the retrocolic and antecolic group respectively (P = 0⋅189). Median percentages of residual activity after 2 h were 64 and 28 per cent respectively (P = 0⋅213). Quality of life did not differ at any time point between the groups. At 2 weeks after surgery, patients with DGE had significantly worse outcomes on two EQ-5D™ domains, ten QLQ-C30/PAN26 subscales, and two GIQLI subscales and total score. Effect sizes were moderate to large. Conclusion:The route of gastroenteric reconstruction after PD does not influence either gastric emptying at scintigraphy or quality of life. The impact of DGE on quality of life is clinically significant. Registration number NTR1697 (www.trialregister.nl).

Long-term health-related quality of life after pancreatic resection for malignancy in patients with and without severe postoperative complications

“…[15][16][17] Previous studies evaluating the difference in QoL between patients with and without complications demonstrate conflicting results. 4,6,[18][19][20] Some studies suggest there are no significant differences in postoperative QoL between patients with or without complications, 6,20 while others show that complications tend to negatively affect postoperative QoL. 4,18,19 Most patients in these studies were part of large randomized clinical trials.…”

“…4,6,[18][19][20] Some studies suggest there are no significant differences in postoperative QoL between patients with or without complications, 6,20 while others show that complications tend to negatively affect postoperative QoL. 4,18,19 Most patients in these studies were part of large randomized clinical trials. In contrast, this study used an unselected patient group to analyse postoperative QoL.…”

Role of Gastric Emptying in Symptoms of Gastroparesis

“…Pancreatoduodenectomy is particular is associated with a high risk of postsurgical Gp. In a study on 73 patients undergoing pancreatoduodenectomy, 27 (36.9%) developed clinically significant delayed gastric emptying post-operatively [77]. Postsurgical Gp may also be seen after other surgeries, including esophagectomy (12%), distal gastrectomy with Roux-en-Y reconstruction (9%), lung transplantation (6%), paraesophageal hernia repair (4.4%) and fundoplication (3.8%) [78][79][80].…”

“…Postsurgical delay in gastric emptying may result in a higher severity of gastrointestinal symptoms. In patients undergoing pancreatoduodenectomy, postsurgical delay in gastric emptying is associated with worse gastrointestinal quality of life [77].…”

Varianten der retrokolischen Rekonstruktion nach partieller Pankreatoduodenektomie und deren Einfluss auf die Magenentleerung – infra- oder suprakolisch

“…Das Auftreten von Erbrechen und die Anwendung prokinetischer Substanzen war in beiden Gruppen gleich verteilt. Trat eine MES auf, so verlängerten sich sowohl die Dauer des Intensivaufenthaltes (3 [1-4,75] vs. 2 [1][2][3] Tage, p = 0,007) als auch die Dauer des Gesamtkrankenhausaufenthaltes (22 [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]75] vs. 18 [14][15][16][17][18][19][20][21][22] Tage, p = 0,001) signifikant. Ein präoperativ vorbestehender Diabetes mellitus war ein Risikofaktor für eine MES (p = 0,047), außerdem zeigten sich weniger MES, wenn Somatostatinanaloga (SA) verabreicht wurden (MES55 % ohne SA, 36 % mit SA, p = 0,034).…”