Does pancreatic enzyme replacement therapy affect survival in patients with pancreatic adenocarcinoma undergoing pancreatic resection?
Petter Frühling, Farima Brandt, Martina Sjöbeck, Björn Lindkvist, Bobby Tingstedt, Hanna SternbyAbstract
Introduction
The pancreas plays a central role in digestion, and a majority of patients with pancreatic cancer suffer from weight loss, cachexia and malnutrition. The aim of this study was to examine the importance of pancreatic enzyme replacement therapy (PERT) on overall survival (OS) in patients resected for pancreatic adenoma carcinoma (PDAC).
Methods
A nationwide population-based study was conducted including all patients resected for PDAC between 2010 and 2019. Data were retrieved from the Swedish National Pancreatic and Periampullary Cancer Registry, and information on administration of pancreatic enzyme supplements (PERT) was obtained from The National Prescribed Drug Register (Läkemedelsregistret).
Results
In total 2279 patients underwent pancreatic resection, out of these 1978 (87%) patients received PERT (PERT-group), and 301 (13%) patients did not (no-PERT). There were no differences between the groups in terms of/with respect to age, sex or ASA classification. Preoperative weight loss (P ≤ 0.001), biliary drainage (P ≤ 0.001) and increased CA19-9 levels (P ≤ 0.001) were more common in the PERT-group. In the PERT-group 72% (n = 1426) of the patients underwent a proximal pancreatic resection, compared to 39% (n = 118) in the no-PERT group (P < 0.0001). In multivariable Cox regression analyses weight loss (95% c.i. HR 1.12 (1.01–1.25)), preoperative biliary drainage (95% c.i. HR 1.35 (1.21–1.51)) were associated with worse OS. PERT administration appeared to positively influence OS (95% c.i. HR 0.83 (0.70–0.99)).
Discussion
Our data suggest that postoperative administration of PERT has a positive impact on OS. Accordingly, we propose that PERT should routinely be prescribed after pancreatic resection.