Pancreas exocrine replacement therapy is associated with increased survival following pancreatoduodenectomy for periampullary malignancy.
HPB (Oxford)
; 19(10): 859-867, 2017 10.
Article
em En
| MEDLINE
| ID: mdl-28711377
ABSTRACT
BACKGROUND:
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.METHODS:
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.RESULTS:
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).DISCUSSION:
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.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Insuficiência Pancreática Exócrina
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Neoplasias Pancreáticas
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Neoplasias dos Ductos Biliares
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Pancreaticoduodenectomia
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Pancrelipase
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Neoplasias Duodenais
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Terapia de Reposição de Enzimas
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article