Pancreatic Fistulas, Preoperative Diabetes Predict Delayed Gastric Emptying after Pancreatic Cancer Surgery

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(ChemotherapyAdvisor) – Pancreatic fistulas and other postoperative complications are associated with more than double the risk of delayed gastric emptying (DGE) after conventional or pyloric-preserving pancreaticoduodenectomy (PD) for pancreatic cancer, according to a meta-analysis of data from 18 studies. The meta-analysis was published online in the European Journal of Surgical Oncology (EJSO).

The new analysis provides “evidence that postoperative complications, pancreatic fistulas and preoperative diabetes were strongly and consistently associated with DGE,” reported Q.S. He, Department of General Surgery, Shandong University Qilu Hospital, Shandong, China, and coauthors.

Antecolic reconstruction and preoperative biliary drainage were associated with a reduced incidence of DGE, the authors found.

The authors pooled data from 18 previously published studies, representing a total of 3,579 patients, in order to assess clinical associations with DGE among patients who have undergone conventional PD or pylorus-preserving pancreaticoduodenectomy (PPPD).

“From the pooled analysis, preoperative diabetes (OR [odds ratio] 1.49; 95% CI: 1.03-2.17), pancreatic fistulas (OR 2.66; 95% CI: 1.65-4.28), and postoperative complications (OR 4.71; 95% CI: 2.61-8.50) were significantly associated with increased risk of DGE,” the authors reported, “while patients with preoperative biliary drainage (OR 0.68; 95% CI: 0.48-0.97) and antecolic reconstruction (OR 0.17; 95% CI: 0.07-041) had decreased risk of DGE development.”

The findings were not affected by gender, jaundice, intraoperative transfusion, surgery type (PD vs. PPPD) or early enteral feeding, the authors noted.

“In nearly all previous studies, the presence of postoperative complications was the most significant risk factor for DGE, and our meta-analysis confirmed this tendency,” the authors reported. “The reasons why postoperative complications may lead to DGE are not fully understood. It has been suggested that gastroparesis as a consequence of local inflammation or abscess may be the main cause of DGE.”

Pancreatic fistula was one of the most frequent such complications, and can cause fatal intraabdominal bleeding or infection, the authors wrote.

“Several abnormalities in diabetes may result in gastric motor dysfunction including autonomic neuropathy, enteric neuropathy involving excitatory and inhibitory nerves, acute fluctuations in blood glucose, incretin-based medications used to normalize postprandial blood glucose and psychosomatic factors,” they reported.

Wider knowledge of DGE risk factors “may assist in identification and appropriate referral of patients at risk,” they concluded.

Abstract

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