A prospective assessment of the natural course of the exocrine pancreatic function in patients with a pancreatic head tumor.
BACKGROUND
In cancer of the pancreatic head region, exocrine insufficiency is a well-known complication, leading to steatorrhea, weight loss, and malnutrition. Its presence is frequently overlooked, however, because the primary attention is focused on cancer treatment. To date, the risk of developing exocrine insufficiency is unspecified. Therefore, we assessed this function in patients with tumors of the pancreatic head, distal common bile duct, or ampulla of Vater.


METHODS
Between March 2010 and August 2012, we prospectively included patients diagnosed with cancer of the pancreatic head region at our tertiary center. To preclude the effect of a resection, we excluded operated patients. Each month, the exocrine function was determined with a fecal elastase test. Furthermore, endocrine function, steatorrhea-related symptoms, and body weight were evaluated. Patients were followed for 6 months, or until death.


RESULTS
Thirty-two patients were included. The tumor was located in the pancreas in 75%, in the bile duct in 16%, and in the ampullary region in 9%, with a median size of 2.5 cm. At diagnosis, the prevalence of exocrine insufficiency was 66%, which increased to 92% after a median follow-up of 2 months (interquartile range, 1 to 4 mo).


CONCLUSIONS
Most patients with cancer of the pancreatic head region were already exocrine insufficient at diagnosis, and within several months, this function was impaired in almost all cases. Given this high prevalence, physicians should be focused on diagnosing and treating exocrine insufficiency, to optimize the nutritional status and physical condition, especially for those patients undergoing palliative chemotherapy and/or radiotherapy.
Departments of *Gastroenterology and Hepatology ‡Surgery †Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
Edmée C M
EC
Sikkens
Djuna L
DL
Cahen
Jill
J
de Wit
Caspar W N
CW
Looman
Casper
C
van Eijck
Marco J
MJ
Bruno
D000368:Aged; D001650:Bile Duct Neoplasms / Q000473:pathology*; D015331:Cohort Studies; D010188:Exocrine Pancreatic Insufficiency / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D046790:Pancreas, Exocrine / Q000503:physiopathology*; D010186:Pancreatic Function Tests; D010190:Pancreatic Neoplasms / Q000473:pathology*; D015995:Prevalence; D011446:Prospective Studies; D045602:Steatorrhea / Q000209:etiology