DISEASE BURDEN AND MANAGEMENT OF PANCREATIC EXOCRINE INSUFFICIENCY IN PATIENTS AFTER PANCREATIC RESECTION IN CHINA: A CROSS-SECTIONAL STUDY
Zipeng Lu*, Kai Zhang, Qian Li, Susu Wang, Kuirong Jiang
Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
Background: Pancreatic exocrine insufficiency (PEI) after pancreatic resections is accompanied with additional disease and economic burden. There is limited data on disease burden and current management practice of PEI after pancreatectomy in China.
Methods: Patients who received pancreatectomies consecutively in a single center for one year were enrolled in this telephone-based interview with predefined questionnaire. Type of surgery included total pancreatectomy (TP), pancreatoduodenectomy (PD), distal pancreatectomy (DP), central pancreatectomy, and enucleation. Disease burden of PEI were assessed with the accumulated number of presenting symptoms related to PEI, and management pattern of PEI were categorized into continuous, discontinued and no-PERT. Patients' demographic and clinical data were collected from the medical history. Symptom burden after vairous types of resections and across different management patterns were described. Univariate and multivariate logistic analyses were used to identify risk factor which may predict the incidence of PEI after partial pancreatectomies as well as potential measures that could promote a good practice of PERT henceforward.
Results: Among 501 patients who were successfully reached at the time of interview, 412 patients took the survey, with a response rate of 82.2%. The median follow-up time was 9.3 months, and the median daily dosage of medication was 60,000 Ph. Eur. Units of lipase. Wider range of resection was associated with heavier burden of symptoms, more weight loss and more patients sticking to the PERT. Patients after TP were associated with 75% of severe symptom burden (≥3 symptoms), a median weight loss of 6 kilograms and 100% of receiving continuous PERT. In stratified analysis, more severe form of PEI was commonly seen in patients with more compliance to PERT but not associated with the procedure per se, indicating overall undertreatment of the disease. Furthermore, only 7% and 26% of the patients in continuous PERT group take additional supplement for snacks and high-fat high-protein diet, respectively. In the multivariate analysis, only low level of preoperative retinal binding protein in the serum and pathology as pancreatic cancer or chronic pancreatitis were associated with presentation of PEI-related symptoms after PD or DP. To improve the convenience of purchasing medication and to increase patients' perception of PEI through education, may be helpful to optimize the treatment of PEI.
Conclusion: PEI in patients after pancreatic resection remains a healthcare challenge in terms of adequate diagnosis and proper treatment. Symptom-based questionnaire provide good assessment tool for PEI evaluation additional to objective laboratory workups. Critical mitigations counteracting underdiagnosis and undertreatment for PEI needs to be defined and implemented in the future.
Back to 2023 Posters