Postoperative Bowel Function and Nutritional Status following Distal Pancreatectomy with En-Bloc Celiac Axis Resection

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Background/Aims: Distal pancreatectomy with en bloc celiac axis resection (DP-CAR) is routinely accompanied by complete resection of the bilateral celiac ganglions and the circumferential plexus of the superior mesenteric artery. The postoperative condition including bowel movement and nutritional status, and tolerance to adjuvant chemotherapy has never been studied. Methods: Forty patients who underwent DP-CAR were enrolled in this study. Postoperative bowel function was estimated by the requirement of antidiarrheal agents. Changes of nutritional parameters including body weight and laboratory data for one year after surgery were evaluated. Results: Fifteen (38%) patients needed no anti-diarrheal agent after a median follow-up period of 39 months. Other patients were well controlled for their bowel movement with anti-diarrheal drugs. Thirteen patients who received adjuvant chemotherapy were well tolerated despite the hematologic toxicity in seven patients who received gemcitabine. Postoperative body weight was significantly decreased and reached a plateau value at 3 postoperative months. The values of laboratory data indicating nutritional status were significantly dropped at 1 month after surgery and recovered between 3 and 12 months. Conclusion: The patients who underwent DP-CAR scarcely suffered from intractable diarrhea, and could achieve a feasible nutritional status after surgery, to be able to receive adjuvant chemotherapy.