title: Partial pancreatic resection for pancreatic malignancy is associated with sustained pancreatic exocrine failure and reduced quality of life: a prospective study.
abstract: OBJECTIVE
  Pancreatic resection for cancer may produce pancreatic exocrine insufficiency (PEI), which is poorly understood. This study examined the coefficient of fat absorption (CFA), symptoms, quality of life (QoL) and the accuracy of faecal elastase-1 (FE-1) measurement to predict PEI.
  
  
  METHODS
  Forty patients were analysed following resection for pancreatic malignancy. The primary endpoint was PEI diagnosis defined by CFA <93%; secondary endpoints were PEI diagnosis using FE-1 <200 μg/g, body mass index (BMI), and symptom and QoL analysis. Interventions were 3-day stool collection, EORTC QLQ-C30 (version 1) questionnaire and patient's diary, at 6 weeks and 3, 6 and 12 months after surgery.
  
  
  RESULTS
  CFA <93% was present in 67% of patients at 6 weeks and in 55% at 12 months. PEI using FE-1 was present in 77 and 83% of patients, respectively. No significant changes between time-points were observed. Sensitivity, specificity, PPV, NPV and accuracy for FE-1 in detecting CFA <93% were 91, 35, 70, 71 and 70%, respectively. CFA and FE-1 levels were uncorrelated. Overall, QoL increased at 6 (p = 0.0212) and 12 (p < 0.0001) months after surgery, mainly driven by physical, role and social functioning, and by appetite. Importantly, however, BMI and symptoms were unaffected by PEI, which suggests a subclinical presentation; such patients had attributes indicating poorer QoL (notably insomnia, p = 0.0012).
  
  
  CONCLUSIONS
  PEI was common and sustained following resection and not associated with significant symptoms. These patients had a tendency toward poorer QoL. FE-1 is a poor surrogate for diagnosing impaired fat absorption. Postoperative pancreatic enzyme replacement should be considered more routinely. and IAP.
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, University of Liverpool, and National Institute for Pancreas Biomedical Research Unit, Liverpool, UK.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Halloran
authors.forename: Trevor F
authors.initials: TF
authors.lastname: Cox
authors.forename: Seema
authors.initials: S
authors.lastname: Chauhan
authors.forename: Michael G T
authors.initials: MG
authors.lastname: Raraty
authors.forename: Robert
authors.initials: R
authors.lastname: Sutton
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.forename: Paula
authors.initials: P
authors.lastname: Ghaneh
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D010188:Exocrine Pancreatic Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism; D005223:Fats / Q000032:analysis / Q000378:metabolism; D005243:Feces / Q000737:chemistry / Q000201:enzymology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010196:Pancreatic Elastase / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000523:psychology / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires
chemical_list: D005223:Fats; D010196:Pancreatic Elastase