Postoperative bowel function and nutritional status following distal pancreatectomy with en-bloc celiac axis resection.
OBJECTIVE
Distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) is routinely accompanied by complete resection of the bilateral celiac ganglions and the circumferential plexus of the superior mesenteric artery. The postoperative condition including bowel movement, nutritional status, and tolerance to adjuvant chemotherapy has never been studied.


METHODS
40 patients who underwent DP-CAR were enrolled in this study. Postoperative bowel function was estimated by the requirement of anti-diarrheal agents. Changes of nutritional parameters including body weight and laboratory data for 1 year after surgery were evaluated.


RESULTS
15 (38%) patients needed no anti-diarrheal agent after a median follow-up period of 39 months. The other patients were well controlled for their bowel movement with anti-diarrheal drugs. 13 patients who received adjuvant chemotherapy tolerated it well despite hematologic toxicity in 7 patients who received gemcitabine. Postoperative body weight was significantly decreased and reached a plateau value at postoperative month 3. The values of laboratory data indicating nutritional status were significantly lower at 1 month after surgery and recovered between 3 and 12 months.


CONCLUSIONS
The patients who underwent DP-CAR scarcely suffered from intractable diarrhea and could achieve a feasible nutritional status after surgery to be able to receive adjuvant chemotherapy.
Hirano
Satoshi
S
Department of Surgical Oncology, Division of Surgery, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan. satto@med.hokudai.ac.jp
Kondo
Satoshi
S
Tanaka
Eiichi
E
Shichinohe
Toshiaki
T
Tsuchikawa
Takahiro
T
Kato
Kentaro
K
Matsumoto
Joe
J
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000930:Antidiarrheals / Q000008:administration & dosage; D001835:Body Weight; D017024:Chemotherapy, Adjuvant; D003967:Diarrhea; D005260:Female; D005728:Ganglia, Sympathetic / Q000601:surgery*; D006801:Humans; D007422:Intestines / Q000503:physiopathology*; D008297:Male; D008638:Mesenteric Arteries / Q000601:surgery; D008875:Middle Aged; D009752:Nutritional Status; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000601:surgery
D000930:Antidiarrheals