World journal of gastrointestinal surgery · 2025
Exocrine pancreatic insufficiency and quality of life after oncologic gastric surgery: Evaluation from a single tertiary center.
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Fiorillo Claudio, Alfieri Sergio, Biffoni Beatrice, Langellotti Lodovica, Lucinato Chiara, Massimiani Giuseppe, Menghi Roberta, De Sio Davide, Puzzangara Maria C, Rosa Fausto, Gentili Vanessa, Gambaro Elisabetta, Tondolo Vincenzo, Quero Giuseppe
Аннотация
BACKGROUND: Gastrectomy is recognized as a potential cause of exocrine pancreatic insufficiency (EPI). However, limited data are available regarding the incidence and impact of EPI on quality of life (QoL) following gastric surgery.
AIM: To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.
METHODS: EPI was assessed using fecal elastase measurement and classified into: (1) No-EPI (fecal elastase > 200 μg/g); (2) Moderate EPI (fecal elastase 100-200 μg/g); and (3) severe EPI (fecal elastase < 100 μg/g). QoL was measured using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire.
RESULTS: Sixteen out of 44 (36.4%) patients developed EPI post-operatively: 9 (56.2%) patients had moderate EPI while 7 (43.8%) patients had severe EPI. Severe EPI was more frequently observed in younger patients (5/7: 71.4%; P = 0.05), in more advanced disease stages (7/7: 100%; P = 0.05), lymph nodes metastases (7/7: 100%; P = 0.04) and in the mixed histotypes (4/7: 66.7%; P = 0.02) compared to the no-EPI and moderate EPI groups. QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score [65 (59-92)] compared to the no-EPI/moderate EPI groups [89 (84-100)] (P = 0.002). Lower scores were particularly evident in the core (P < 0.0001) and disease-specific symptoms domains (P = 0.002) in the severe EPI group compared to the no-EPI/moderate EPI groups.
CONCLUSION: Gastrectomy is a cause of EPI. Younger patients, aggressive disease and advanced stages are significant risk factors for more severe EPI. Severe EPI worsens QoL, being associated with a higher rate of gastrointestinal symptoms.
AIM: To evaluate incidence and severity of EPI after gastrectomy and its effect on QoL at least one year after surgery.
METHODS: EPI was assessed using fecal elastase measurement and classified into: (1) No-EPI (fecal elastase > 200 μg/g); (2) Moderate EPI (fecal elastase 100-200 μg/g); and (3) severe EPI (fecal elastase < 100 μg/g). QoL was measured using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire.
RESULTS: Sixteen out of 44 (36.4%) patients developed EPI post-operatively: 9 (56.2%) patients had moderate EPI while 7 (43.8%) patients had severe EPI. Severe EPI was more frequently observed in younger patients (5/7: 71.4%; P = 0.05), in more advanced disease stages (7/7: 100%; P = 0.05), lymph nodes metastases (7/7: 100%; P = 0.04) and in the mixed histotypes (4/7: 66.7%; P = 0.02) compared to the no-EPI and moderate EPI groups. QoL analysis showed that severe EPI was associated with a significantly lower overall GIQLI score [65 (59-92)] compared to the no-EPI/moderate EPI groups [89 (84-100)] (P = 0.002). Lower scores were particularly evident in the core (P < 0.0001) and disease-specific symptoms domains (P = 0.002) in the severe EPI group compared to the no-EPI/moderate EPI groups.
CONCLUSION: Gastrectomy is a cause of EPI. Younger patients, aggressive disease and advanced stages are significant risk factors for more severe EPI. Severe EPI worsens QoL, being associated with a higher rate of gastrointestinal symptoms.