General and Oncologic Surgery, Department of Oncology, San Filippo Neri Hospital, Rome, Italy.
Direttore UOC Chirurgia Generale, Ospedale "C. e G. Mazzoni", AV5-ASUR Marche, Via degli Iris, 63100, Ascoli Piceno, Italy.
Gastric Cancer. 2018 May;21(3):542-551. doi: 10.1007/s10120-017-0757-y. Epub 2017 Aug 14.
Gastrectomy for gastric cancer is a significant cause of secondary exocrine pancreatic insufficiency. Pancreatic enzyme replacement therapy may influence nutritional status and quality of life after gastrectomy, but the pertinent clinical research to date remains controversial. A randomized controlled trial to test this hypothesis was carried out.
After gastrectomy, 43 patients with gastric cancer were randomly assigned to a normal diet (Normal-d; n = 21) or to a pancreatic enzyme supplementation diet (PES-d; n = 22) and were followed up during a 12-month period, assessing nutritional status and quality of life through body mass index (BMI), instant nutritional assessment (INA) class status, serum pre-albumin (SPA) values, and GastroiIntestinal Quality of Life Index (GIQLI).
BMI was not significantly influenced by the type of diet; INA class status was significantly improved in the PES-d arm, particularly during the first 3 months after gastrectomy; SPA levels increased in both arms at 6 months after gastrectomy, reaching significantly higher values in the PES-d arm at 12 months. GIQLI was not significantly influenced by the type of diet throughout the follow-up period; however, this index significantly improved in the PES-d arm between the first and third month after gastrectomy.
PES-d improves nutritional status and quality of life after gastrectomy for gastric cancer, particularly within 3 months from the operation. A larger, multicenter trial is necessary to address the potential influence of several confounding variables such as disease stage and adjuvant treatments.
胃癌胃切除术是引起继发性外分泌胰腺功能不全的重要原因。胰腺酶替代治疗可能会影响胃切除术后的营养状况和生活质量，但目前相关的临床研究仍存在争议。为此开展了一项随机对照试验来验证这一假说。
43 例胃癌胃切除术后患者被随机分配到正常饮食组（Normal-d；n=21）或胰酶补充饮食组（PES-d；n=22），并在 12 个月的随访期间评估营养状况和生活质量，通过体重指数（BMI）、即时营养评估（INA）类别状态、血清前白蛋白（SPA）值和胃肠道生活质量指数（GIQLI）进行评估。
饮食类型对 BMI 没有显著影响；PES-d 组的 INA 类别状态显著改善，尤其是在胃切除术后的前 3 个月；两组 SPA 水平均在胃切除术后 6 个月升高，在 12 个月时 PES-d 组的 SPA 水平显著升高。在整个随访期间，饮食类型对 GIQLI 没有显著影响；然而，PES-d 组在胃切除术后第 1 至第 3 个月之间，该指数显著改善。
PES-d 可改善胃癌胃切除术后的营养状况和生活质量，特别是在术后 3 个月内。需要更大规模的多中心试验来解决疾病分期和辅助治疗等多种混杂因素的潜在影响。
