Exocrine pancreatic insufficiency and quality of life after oncologic gastric surgery: Evaluation from a single tertiary center.

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.