Denda Y, Matsuo Y, Hosogi R, Ishida M, Uehara Y, Sugita S, Eguchi Y, Nonoyama K, Murase H, Kato T, Saito K, Sato T, Yamakawa Y, Sagawa H, Ogawa R, Mitsui A, Takiguchi S. Effects of rikkunshito administration after distal pancreatectomy on postoperative oral intake and weight loss. World J Gastrointest Surg 2026; 18(7): 122205 [DOI: 10.4240/wjgs.v18.i7.122205]
Corresponding Author of This Article
Yoichi Matsuo, MD, PhD, Professor, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Aichi, Japan. matsuo@med.nagoya-cu.ac.jp
Research Domain of This Article
Surgery
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research-article
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Denda Y, Matsuo Y, Hosogi R, Ishida M, Uehara Y, Sugita S, Eguchi Y, Nonoyama K, Murase H, Kato T, Saito K, Sato T, Yamakawa Y, Sagawa H, Ogawa R, Mitsui A, Takiguchi S. Effects of rikkunshito administration after distal pancreatectomy on postoperative oral intake and weight loss. World J Gastrointest Surg 2026; 18(7): 122205 [DOI: 10.4240/wjgs.v18.i7.122205]
Yuki Denda, Ryosuke Hosogi, Masaki Ishida, Yuriko Uehara, Saburo Sugita, Yuki Eguchi, Keisuke Nonoyama, Hiromichi Murase, Tomokatsu Kato, Kenta Saito, Takafumi Sato, Yushi Yamakawa, Hiroyuki Sagawa, Ryo Ogawa, Akira Mitsui, Shuji Takiguchi, Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Aichi, Japan
Yoichi Matsuo, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, Nagoya 464-8547, Aichi, Japan
Author contributions: Denda Y conceptualized and designed the study, collected the data, performed the analysis, and drafted the manuscript; Matsuo Y supervised the study and critically revised the manuscript for important intellectual content; Takiguchi S supervised the statistical analysis and critically reviewed the manuscript; all authors reviewed and approved the final version of the manuscript.
AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement and formatting assistance. No AI tool was involved in the generation of research data, interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.
Institutional review board statement: This study was approved by the Institutional Review Board of Nagoya City University Graduate School of Medical Sciences (approval No. 60-24-0099).
Informed consent statement: The requirement for written informed consent was waived because of the retrospective nature of the study. Instead, an opt-out approach was used, and study information was disclosed on the institutional website in accordance with the ethical guidelines.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest related to this study.
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: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Yoichi Matsuo, MD, PhD, Professor, Department of Gastroenterological Surgery, Nagoya City University East Medical Center, 1-2-23 Wakamizu, Chikusa-ku, Nagoya 464-8547, Aichi, Japan. matsuo@med.nagoya-cu.ac.jp
Received: April 13, 2026 Revised: May 9, 2026 Accepted: May 26, 2026 Published online: July 27, 2026 Processing time: 106 Days and 2.2 Hours
Abstract
BACKGROUND
Reduced oral intake and postoperative weight loss are common after distal pancreatectomy and may impair postoperative recovery and tolerance to adjuvant therapy. Rikkunshito (RT), a traditional Japanese Kampo medicine, has been reported to improve appetite and gastrointestinal function. However, its clinical impact after distal pancreatectomy remains unclear.
AIM
To evaluate the association between postoperative RT administration and oral intake, as well as body weight loss, after distal pancreatectomy.
METHODS
This retrospective cohort study included 241 patients who underwent distal pancreatectomy at a single hepatobiliary-pancreatic center between July 2005 and July 2024. Patients were divided into an RT (+) group (n = 117) and an RT (-) group (n = 124) according to whether or not they received postoperative RT. The primary endpoint was oral intake on postoperative day (POD) 7. The secondary endpoint was change in body weight from before surgery to 1 month after surgery.
RESULTS
Oral intake on POD 7 was significantly higher in the RT (+) group than in the RT (-) group. The median weight loss at 1 month postoperatively was -2.00 kg in the RT (+) group and -2.65 kg in the RT (-) group, indicating a smaller degree of weight loss in the RT (+) group (P = 0.044). The differences between the groups in the development of clinically relevant postoperative pancreatic fistulas, delayed gastric emptying, or major complications (Clavien-Dindo grade ≥ IIIa) were not significant. By multivariable analysis adjusted for age, preoperative body mass index, and major postoperative complications, RT administration remained independently associated with reduced postoperative body weight loss.
CONCLUSION
The postoperative administration of RT was associated with improved oral intake and reduced body weight loss after distal pancreatectomy, without increasing postoperative complications. RT may be effective for the early postoperative nutritional management of patients after distal pancreatectomy.
Core Tip: Postoperative weight loss and reduced oral intake are common problems after distal pancreatectomy and may adversely affect postoperative recovery and tolerance to adjuvant therapy. Rikkunshito (RT), a traditional Japanese herbal medicine, is reported to improve appetite and gastrointestinal motility. In this retrospective study, patients who received RT after distal pancreatectomy showed significantly improved oral intake on postoperative day 7 and less body weight loss 1 month postoperatively compared with those who did not receive RT. In the absence of established strategies for early postoperative nutritional support after distal pancreatectomy, these findings provide clinically relevant evidence for a simple and feasible intervention.
