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SHR Neuro Cancer Cardio Lipid Metab Microb

Roberts, KJ; Schrem, H; Hodson, J; Angelico, R; Dasari, BVM; Coldham, CA; Marudanayagam, R; Sutcliffe, RP; Muiesan, P; Isaac, J; Mirza, DF.
Pancreas exocrine replacement therapy is associated with increased survival following pancreatoduodenectomy for periampullary malignancy.
HPB (Oxford). 2017; 19(10): 859-867. Doi: 10.1016/j.hpb.2017.05.009 [OPEN ACCESS]
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Co-authors Med Uni Graz: Schrem Harald Heinrich
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Abstract:: Although many patients undergoing pancreatoduodenectomy (PD) for cancer have pancreatic exocrine insufficiency, pancreatic enzyme replacement therapy (PERT) is not routinely used, and effects upon post-operative survival are unclear. This review of patients undergoing PD for periampullary malignancy sought to test for an association between PERT and overall survival, with post-hoc subgroup analysis performed after stratifying patients by the year of surgery, pancreatic duct width and tumour type. Some 202/469 (43.1%) patients received PERT. After accounting for pathological variables and chemotherapy, PERT use was found to be independently associated with improved survival on multivariable analysis [HR 0.72 (95% CI: 0.52-0.99), p = 0.044] and on propensity matched analysis (p = 0.009). The effect of PERT upon improved survival was predominantly observed amongst patients with a dilated pancreatic duct (≥3 mm). PERT use was independently associated with improved survival following PD for cancer. The validity of this observation is supported by an effect largely confined to those patients with a dilated pancreatic duct. The nutritional status of patients undergoing PD for cancer needs further investigation and the effects of PERT require verification in further clinical studies. Copyright © 2017. Published by Elsevier Ltd.
Find related publications in this database (using NLM MeSH Indexing): Aged -; Bile Duct Neoplasms - mortality; Bile Duct Neoplasms - pathology; Bile Duct Neoplasms - surgery; Disease Progression -; Disease-Free Survival -; Duodenal Neoplasms - mortality; Duodenal Neoplasms - pathology; Duodenal Neoplasms - surgery; Enzyme Replacement Therapy - adverse effects; Enzyme Replacement Therapy - mortality; Exocrine Pancreatic Insufficiency - drug therapy; Exocrine Pancreatic Insufficiency - enzymology; Exocrine Pancreatic Insufficiency - etiology; Exocrine Pancreatic Insufficiency - mortality; Female -; Humans -; Kaplan-Meier Estimate -; Logistic Models -; Male -; Middle Aged -; Multivariate Analysis -; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pancreaticoduodenectomy - adverse effects; Pancreaticoduodenectomy - mortality; Pancrelipase - adverse effects; Pancrelipase - therapeutic use; Propensity Score -; Proportional Hazards Models -; Retrospective Studies -; Risk Factors -; Time Factors -; Treatment Outcome -