Surmelioglu Ali, Ozkardesler Ersan, Tilki Metin, Yekrek Murat
Department of Gastrointestinal Surgery, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Department of General Surgery, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Pancreatology. 2021 Aug;21(5):975-982. doi: 10.1016/j.pan.2021.03.019. Epub 2021 Apr 1.
Exocrine pancreatic insufficiency (EPI) can be a problem following gastrectomies. This study aimed to reveal the EPI prevalence and its possible causes in gastric cancer patients that underwent subtotal or total gastrectomy, with completed oncological treatments, and with long-term disease-free survival success. Additionally, we also sought to determine whether there were any relations between EPI and blood biomarkers, weight change, malnutrition parameters, and quality of life after gastrectomy.
A total of 69 gastric cancer patients whose oncological treatments had already been completed, with a minimum follow-up period of 16 months, were included in the study. Fecal samples were taken from all patients for the Fecal Elastase-1 Test, and patients were stratified into three groups based on the results: low (<100 μg/g), moderate (100-200 μg/g), and normal (>200 μg/g). These results were compared with patients' clinical characteristics, blood nutrition biomarkers, Maastricht indexes (MI), Bristol stool scale, and Gastrointestinal Quality of Life Index (GIQLI) scores.
FE-1 levels were low in 33 (47.8%) of the patients, moderate in 11 (15.9%), and normal in 25 (36.2%). The rate of patients receiving chemoradiotherapy (CRT) in the low FE-1 group was higher than the normal FE-1 and moderate FE-1 groups (P < 0.001 and P = 0.012, respectively). The serum total protein and lipase levels were lower in the low FE-1 group than in the normal FE-1 group (P = 0.023 and P < 0.001, respectively). When compared to the normal FE-1 group, the MI score of the low FE-1 group was higher (P = 0.018). The low FE-1 group had lower GIQLI gastrointestinal symptom scores than the normal FE-1 group (P = 0.046).
During long-term follow-up, EPI can be seen in more than half of patients with gastric cancer after curative gastrectomy. Radiotherapy as an adjunct to adjuvant treatment in the postoperative period is considered a serious risk factor for EPI development. EPI contributes to malnutrition development after gastrectomy and negatively affects the patients' quality of life, especially in terms of gastrointestinal symptoms.
胃切除术后外分泌性胰腺功能不全（EPI）可能成为一个问题。本研究旨在揭示接受次全或全胃切除术、完成肿瘤治疗且长期无病生存的胃癌患者中EPI的患病率及其可能原因。此外，我们还试图确定EPI与血液生物标志物、体重变化、营养不良参数以及胃切除术后生活质量之间是否存在任何关联。
本研究共纳入69例已完成肿瘤治疗且最短随访期为16个月的胃癌患者。采集所有患者的粪便样本进行粪便弹性蛋白酶-1检测，并根据结果将患者分为三组：低水平（<100μg/g）、中等水平（100 - 200μg/g）和正常水平（>200μg/g）。将这些结果与患者的临床特征、血液营养生物标志物、马斯特里赫特指数（MI）、布里斯托大便分类法以及胃肠道生活质量指数（GIQLI）评分进行比较。
33例（47.8%）患者的FE-1水平较低，11例（15.9%）为中等水平，25例（36.2%）为正常水平。低FE-1组接受放化疗（CRT）的患者比例高于正常FE-1组和中等FE-1组（分别为P < 0.001和P = 0.012）。低FE-1组的血清总蛋白和脂肪酶水平低于正常FE-1组（分别为P = 0.023和P < 0.001）。与正常FE-1组相比，低FE-1组的MI评分更高（P = 0.018）。低FE-1组的GIQLI胃肠道症状评分低于正常FE-1组（P = 0.046）。
在长期随访中，根治性胃切除术后超过一半的胃癌患者会出现EPI。术后放疗作为辅助治疗手段被认为是EPI发生的一个严重危险因素。EPI会导致胃切除术后营养不良的发生，并对患者的生活质量产生负面影响，尤其是在胃肠道症状方面。
