Exocrine pancreatic insufficiency following gastrectomy and quality of life in patients undergoing gastric resection for malignancy

Rajeevan, P S (2019) Exocrine pancreatic insufficiency following gastrectomy and quality of life in patients undergoing gastric resection for malignancy. Masters thesis, Christian Medical College, Vellore.


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BACKGROUND: Gastrectomy for adenocarcinoma stomach is a major procedure that causes significant morbidity to the patient and can influence the quality of life of patients. One major concerns following gastrectomy is the complaints of post-operative steatorrhea and weight loss which is attributed to lipid malabsorption. One of the postulated causes of lipid malabsorption following gastrectomy and Roux en Y reconstruction is exocrine pancreatic enzyme insufficiency. AIM AND OBJECTIVES: To find the incidence of exocrine pancreas insufficiency following gastrectomy, for gastric cancer and to assess the quality of life in patients undergoing gastric resection for malignancy. MATERIALS AND METHOD: This was a cross-sectional study among patients undergoing gastric resection for adenocarcinoma in the Upper GI surgical unit, Department of General Surgery in Christian Medical College, Vellore. Patients planned for gastrectomy fulfilling the study recruitment criteria and consented for the study were tested for stool elastase pre-operatively and post-operatively. Continuous sampling of all eligible patients were done till sample size was reached. All patients who underwent gastrectomy for adenocarcinoma stomach during the study period in 2017 were assessed for quality of life using a semi structured questionnaire from a validated questionnaire EORTC QLQ C30 and EORTC QLQ STO22 during their postoperative period. Retrospective QOL analysis was performed on the patients who had undergone gastrectomy for adenocarcinoma stomach between the years 2013 and 2016. Data was entered using Epidata 3.1 and analysed using SPSS 23. RESULTS: The incidence of exocrine pancreatic insufficiency calculated by stool elastase testing in subtotal and total gastrectomy was 40% and 16.7% respectively. The overall incidence of exocrine pancreatic insufficiency in gastrectomy was 34.6% None of the patients in the study had significant clinical symptoms suggestive of steatorrhea or fat malabsorption. The was no statistical difference between total and subtotal gastrectomy with the incidence of exocrine pancreatic insufficiency. More number of patients at 1-year follow-up have higher pain and eating restriction score which decreases as the follow up time period increases. Quality of life score was not influenced by the type of gastrectomy, method of surgery, stage of disease at presentation or the resection intent. As the follow up time period from time of surgery increases by a month, the overall quality of life score decreases by 2 points. CONCLUSIONS: The incidence of exocrine pancreatic insufficiency following gastric resection for malignancy is low in our population compared to the Western data. Routine supplementation of pancreatic enzyme supplements to all patients undergoing gastrectomy may not be required. However, screening for pancreatic insufficiency by stool elastase testing, in the subgroup of patients who are malnourished or have symptoms of fat malabsorption may help detect this problem, which can be addressed effectively by exocrine pancreatic supplementation.

Item Type: Thesis (Masters)
Additional Information: Reg.No.221611459
Uncontrolled Keywords: Gastrectomy, Exocrine pancreatic insufficiency, Quality of life, Stool elastase.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 02 Sep 2019 06:08
Last Modified: 02 Sep 2019 06:08
URI: http://repository-tnmgrmu.ac.in/id/eprint/11390

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