Exocrine function following the whipple operation as assessed by stool elastase.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Surgery

Background:

• Pancreaticoduodenectomy (PD) is a major surgical procedure for various pancreatic and periampullary diseases.
• Assessing the impact of PD on pancreatic exocrine function and the patency of the pancreatic anastomosis is crucial for patient outcomes.

Purpose of the Study:

• To evaluate the effect of pancreaticoduodenectomy (PD) on exocrine function using stool elastase measurements.
• To assess the patency of the pancreatic anastomosis after PD using CT scans.
• To identify patient groups at higher risk for exocrine insufficiency post-PD.

Main Methods:

• Prospective measurement of stool elastase in 182 patients undergoing PD from December 2001 to March 2006.
• Postoperative stool elastase and abdominal CT scans were performed at 3, 12, and 24 months.
• Pancreatic anastomosis patency was inferred from pancreatic duct dilation in the remnant on CT scans.

Main Results:

• Preoperative normal stool elastase was observed in 78% of patients, but significantly lower in pancreatic cancer patients (32%).
• Postoperatively, reduced elastase levels were found in 48% at 3 months, 73% at 1 year, and 50% at 2 years.
• Pancreatic duct dilation, indicating potential anastomotic issues, was infrequent (9%) and not associated with decreased elastase levels.

Conclusions:

• One-third of patients develop exocrine insufficiency after PD, with pancreatic cancer patients being most affected (68%).
• Parenchymal loss, not anastomotic occlusion, is the primary driver of reduced exocrine function post-PD.
• Routine exocrine supplementation is recommended for pancreatic cancer patients post-PD, especially before adjuvant therapy.