title: Pancreaticoduodenectomy for peri-ampullary neoplasia leads to specific micronutrient deficiencies.
abstract: OBJECTIVE
  After pancreaticoduodenectomy (PD) patients may be deficient in essential micronutrients. This study was designed to determine if this is a consequence of surgery.
  
  
  METHODS
  Long-term survivors (>6 months) of PD for peri-ampullary neoplasia and healthy controls (patients' spouse/partner) were enrolled in the study. Specific clinical parameters were recorded, serum micronutrient levels were measured and subjects completed 7-day food diaries.
  
  
  RESULTS
  Thirty-seven patients were studied, 25 with paired controls. All were well nourished, as defined by body mass index and food diary analysis. Patients with paired controls were representative of all patients studied. Patients had raised transferrin (median 2.60 vs. 2.16 g/l, p = 0.001) and low ferritin levels (34.9 vs. 119.0 g/l, p < 0.001) indicating relative iron deficiency. Patients also demonstrated lower levels of the anti-oxidants selenium (0.77 vs. 0.93 micromol/l, p < 0.001) and vitamin E (23.2 vs. 35.7 micromol/l, p < 0.001) with 57% of patients having frank selenium deficiencies. Patients had lower levels of vitamin D than controls (15.7 vs. 19.6 micromol/l, p = 0.001) and 30% of patients had a raised parathyroid hormone level, suggesting compensatory mechanisms operate to maintain normocalcaemia.
  
  
  CONCLUSIONS
  Long-term survivors of PD are relatively deficient in several micronutrients compared to non-operated controls taking the same diet. We recommend that micronutrient status should be regularly checked in these patients and treated where necessary.
authors: University Department of Surgery, Southampton General Hospital, Southampton, UK. armstongthomas@talk21.com
authors: T
authors: T
authors: Armstrong
authors: L
authors: L
authors: Strommer
authors: F
authors: F
authors: Ruiz-Jasbon
authors: F W
authors: FW
authors: Shek
authors: S F
authors: SF
authors: Harris
authors: J
authors: J
authors: Permert
authors: C D
authors: CD
authors: Johnson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001361:Avitaminosis / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000097:blood / Q000172:deficiency*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D017741:Survivors; D014131:Trace Elements / Q000097:blood / Q000172:deficiency; D014815:Vitamins / Q000097:blood
chemical_list: D018977:Micronutrients; D014131:Trace Elements; D014815:Vitamins