Fiorillo C, Alfieri S, Biffoni B, Langellotti L, Lucinato C, Massimiani G, Menghi R, De Sio D, Puzzangara MC, Rosa F, Gentili V, Gambaro E, Tondolo V, Quero G. Exocrine pancreatic insufficiency and quality of life after oncologic gastric surgery: Evaluation from a single tertiary center. World J Gastrointest Surg 2025; 17(9): 107789 [DOI: 10.4240/wjgs.v17.i9.107789]
Corresponding Author of This Article
Beatrice Biffoni, MD, Digestive Surgery Unit, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo Agostino Gemelli 8, Roma 00168, Italy. beatrice.biffoni@guest.policlinicogemelli.it
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 107789 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.107789
Exocrine pancreatic insufficiency and quality of life after oncologic gastric surgery: Evaluation from a single tertiary center
Claudio Fiorillo, Sergio Alfieri, Beatrice Biffoni, Lodovica Langellotti, Chiara Lucinato, Giuseppe Massimiani, Roberta Menghi, Davide De Sio, Maria C Puzzangara, Fausto Rosa, Vanessa Gentili, Elisabetta Gambaro, Vincenzo Tondolo, Giuseppe Quero
Claudio Fiorillo, Sergio Alfieri, Beatrice Biffoni, Lodovica Langellotti, Chiara Lucinato, Giuseppe Massimiani, Roberta Menghi, Davide De Sio, Elisabetta Gambaro, Giuseppe Quero, Digestive Surgery Unit, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Roma 00168, Italy
Sergio Alfieri, Roberta Menghi, Maria C Puzzangara, Fausto Rosa, Giuseppe Quero, Department of Surgery, Università Cattolica del Sacro Cuore di Roma, Roma 00168, Italy
Vanessa Gentili, U.O.C. Laboratorio Analisi, Ospedale San Giovanni Evangelista, Tivoli 00019, Lazio, Italy
Vincenzo Tondolo, Digestive Surgery Unit, Fatebenefratelli Isola Tiberina–Gemelli Isola, Roma 00186, Italy
Author contributions: Fiorillo C and Biffoni B conceptualized the study; Alfieri S and Tondolo V supervised the project; Langellotti L and Quero G wrote the original draft of the manuscript; Lucinato C, Massimiani G, and Gentili V performed the analysis and investigation; Menghi R, De Sio D, and Gambaro E were responsible for the methodology; Puzzangara MC and Rosa F reviewed and edited the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Institutional review board statement: The study was approved by the Institutional Review Board and the Ethical Committee.
Informed consent statement: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent to be included in the study, or the equivalent, was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at beatrice.biffoni@guest.policlinicogemelli.it. Patients' consent for data sharing was not obtained but the presented data are anonymized and risk of identification is low.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Beatrice Biffoni, MD, Digestive Surgery Unit, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo Agostino Gemelli 8, Roma 00168, Italy. beatrice.biffoni@guest.policlinicogemelli.it
Received: March 30, 2025 Revised: April 14, 2025 Accepted: July 18, 2025 Published online: September 27, 2025 Processing time: 179 Days and 16.8 Hours
Abstract
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.
Core Tip: Gastrectomy is a recognized cause of exocrine pancreatic insufficiency (EPI), yet its impact on quality of life (QoL) remains under-investigated. This study confirms gastrectomy as a significant contributor to EPI and identifies younger age, advanced stage, and aggressive histology as risk factors for more severe forms. Severe EPI is associated with a higher burden of gastrointestinal symptoms and leads to a notable deterioration in postoperative QoL.
