Early Versus Delayed Pancreatic Enzyme Replacement Therapy After Pancreatic Cancer Surgery: A Real-World Cohort Study.

OBJECTIVES

The optimal timing of pancreatic enzyme replacement therapy (PERT) after pancreatic surgery for pancreatic cancer remains uncertain. We compared outcomes after early versus delayed PERT initiation in a real-world cohort.

METHODS

This retrospective cohort study used the TriNetX US Collaborative Network database. Adults with pancreatic cancer undergoing pancreatic surgery were categorized as early PERT if treatment was started within 1 month after surgery, and late PERT if started between 2 and 3 months after surgery. Outcomes were assessed from 90 to 730 days after the index event. Comparative analyses were performed after 1:1 propensity score matching.

RESULTS

Before matching, 3960 patients were identified in the late PERT cohort and 9807 in the early PERT cohort; after matching, 3948 patients were retained in each group. All-cause mortality was similar between the late and early PERT cohorts (1076/3871 [27.8%] vs. 1022/3831 [26.7%]; risk ratio [RR]: 1.042; 95% CI: 0.969-1.121; P =0.270; hazard ratio [HR]: 1.018; 95% CI: 0.935-1.109; log-rank P =0.677). Emergency department visits were also similar (35.7% vs. 34.3%; RR: 1.042; 95% CI: 0.981-1.107; P =0.179). Late PERT was associated with higher risk of diarrhoea (31.0% vs. 28.9%; RR: 1.072; 95% CI: 1.002-1.147; P =0.044) and albumin <3.5 g/dL (62.7% vs. 58.8%; RR: 1.066; 95% CI: 1.029-1.105; P <0.001; HR: 1.076; 95% CI: 1.017-1.139; log-rank P =0.011).

CONCLUSIONS

Delayed PERT initiation was not associated with higher mortality or emergency department utilization but was associated with higher diarrhea and hypoalbuminemia risk.