Pancreatic atrophy after gastrectomy for gastric cancer
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ORIGINAL ARTICLE
Pancreatic atrophy after gastrectomy for gastric cancer Ryo Takahashi1,2 · Souya Nunobe1 · Naohito Sai1 · Rie Makuuchi1 · Satoshi Ida1 · Koshi Kumagai1 · Manabu Ohashi1 · Takeshi Sano1 Received: 26 May 2020 / Accepted: 27 July 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose To investigate the phenomenon of pancreatic atrophy after gastrectomy for gastric cancer, using computed tomography (CT) volumetry. Methods The subjects of this retrospective study were 77 patients who underwent distal gastrectomy (DG) or total gastrectomy (TG) for pStage I gastric cancer in 2014. The relative pancreatic volume ratio was assessed preoperatively, and then 1 and 5 years postoperatively and the results were compared between surgical procedures Results A total of 14 patients underwent TG with Roux-en-Y (RY) reconstruction, 24 underwent DG with Billroth-I (BI) reconstruction, and 39 underwent DG with RY reconstruction. We observed that the pancreatic volume continued to decrease over the 5 years after DG or TG. Furthermore, the incidence of pancreatic atrophy 5 years postoperatively was significantly greater after TG than after DG. In patients who underwent DG, a greater incidence of pancreatic atrophy was observed after RY reconstruction than after BI reconstruction, 5 years postoperatively. Conclusion The pancreatic volume continued to decrease after DG and TG for gastric cancer 5 years after treatment. TG was associated with a significantly greater incidence of pancreatic atrophy than DG 5 years postoperatively, as was RY reconstruction vs. BI reconstruction after DG. Keywords Gastrectomy · Pancreatic atrophy · Pancreatic volumetry
Introduction Gastric cancer is the fifth most common cancer diagnosed worldwide, affecting approximately 1 million new people every year [1]. Surgical resection remains the standard curative treatment for gastric cancer that is not indicated for endoscopic resection [2]. However, gastrectomy can lead to malnutrition and weight loss, with a decline in quality of life [3]. These side-effects occur through various mechanisms [4]. The exocrine pancreas plays a key role in digestive Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00595-020-02131-2) contains supplementary material, which is available to authorized users. * Souya Nunobe [email protected] 1
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3‑8‑31, Ariake, Koto‑ku, Tokyo 135‑8550, Japan
Department of General Surgery, Hekinan Municipal Hospital, Aichi, Japan
2
function via the secretion of pancreatic digestive enzymes, including amylase, protease, and lipase, which facilitate macronutrient digestion in the chyme [5]. Exocrine pancreatic insufficiency, which is caused by the reduction or absence of stimulation, production, or delivery of pancreatic digestive enzymes to the bowel lumen, is considered to play a key role [6, 7]. The morphology of the pancreas has been investigated usi
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