Pancreas exocrine replacement therapy is associated with increased survival following pancreatoduodenectomy for periampullary malignancy. Issue 10 (October 2017)

• Record Type: Journal Article
• Authors: Roberts, Keith J.; Schrem, Harald; Hodson, James; Angelico, Roberta; Dasari, Bobby V.M.; Coldham, Chris A.; Marudanayagam, Ravi; Sutcliffe, Robert P.; Muiesan, Paolo; Isaac, John; Mirza, Darius F.
• Is Part Of: HPB. Volume 19:Issue 10(2017)
• Page Start: 859
• Page End: 867
• Publication Date: 2017-10
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2017.05.009
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Although many patients undergoing pancreatoduodenectomy (PD) for cancer have pancreatic exocrine insufficiency, pancreatic enzyme replacement therapy (PERT) is not routinely used, and effects upon post-operative survival are unclear. Methods: This review of patients undergoing PD for periampullary malignancy sought to test for an association between PERT and overall survival, with post-hoc subgroup analysis performed after stratifying patients by the year of surgery, pancreatic duct width and tumour type. Results: Some 202/469 (43.1%) patients received PERT. After accounting for pathological variables and chemotherapy, PERT use was found to be independently associated with improved survival on multivariable analysis [HR 0.72 (95% CI: 0.52–0.99), p = 0.044] and on propensity matched analysis (p = 0.009). The effect of PERT upon improved survival was predominantly observed amongst patients with a dilated pancreatic duct (≥3 mm). Discussion: PERT use was independently associated with improved survival following PD for cancer. The validity of this observation is supported by an effect largely confined to those patients with a dilated pancreatic duct. The nutritional status of patients undergoing PD for cancer needs further investigation and the effects of PERT require verification in further clinical studies.