The need for life-long holistic follow-up after pancreaticoduodenectomy

Pancreaticoduodenectomy (PD) results in surgical, metabolic and nutritional consequences with unknown frequency.

This observational single centre study attempted to quantify the incidence of the long-term consequences after PD in patients offered routine surveillance with a specialist dietitian and nurse specialist.

One hundred and thirty-four patients participated (52 % male, mean age 64.7 years [SD 10.2]. The mean time from surgery was 4.48 years [SD 3.7]. Malnutrition occurred in <10 %. Consequences were experienced by 82 % of patients (mean number 2.02, [SD 1.52]), 28 % were related to the surgical anastomosis. Eight patients (6 %) had late revisional surgery. Metabolic and gastrointestinal consequences were common, and >50 % had diabetes after 2 years. Pancreatin doses increased with time, with mean mealtime doses of 54,449 units of lipase [SD 19,452] increasing to 100,450 units [SD 33,351] by 10 years (p < 0.001). The onset of complications was associated with time from surgery (p < 0.001) but not histology or use of chemotherapy.

Our study is the first to provide data on the long-term consequences of PD (>10 years). Long-term screening for malnutrition, diabetes, micronutrient deficiency, steatotic liver disease, ongoing abdominal symptoms, and osteoporosis should be routine after PD, and cost benefit analysis undertaken to support the allocation of appropriate funding.