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

Table 1 Clinico-demographic characteristics of the study population and comparative analysis between no-exocrine pancreatic insufficiency and exocrine pancreatic insufficiency cohorts, n (%)

Variables	Study population (n = 44)	No-EPI (n = 28)	EPI (n = 16)	P value
Sex
Male	26 (59.1)	16 (57.1)	10 (62.5)	0.73
Female	18 (40.9)	12 (42.9)	6 (37.5)
Age
≥ 65	26 (59.1)	16 (57.1)	10 (62.5)	0.73
< 65	18 (40.9)	12 (42.9)	6 (37.5)
Comorbidities
Diabetes	7 (15.9)	3 (10.7)	4 (25)	0.15
Cardiovascular disease	11 (25)	6 (21.4)	5 (31.3)
Pulmonary disease	7 (15.9)	2 (7.1)	5 (31.3)
ASA score
ASA 1	0	0	0	0.46
ASA 2	36 (81.8)	22 (78.6)	14 (87.5)
ASA 3	8 (18.2)	6 (21.4)	2 (12.5)
Tumor location
Proximal	14 (31.8)	10 (35.7)	4 (25)	0.43
Middle	7 (15.9)	3 (10.7)	4 (25)
Distal	23 (52.3)	15 (53.6)	8 (50)
Neoadjuvant therapy	25 (56.8)	14 (50)	11 (68.8)	0.23
Type of surgical procedure
STG	26 (59.1)	17 (60.7)	9 (56.2)	0.18
Total gastrectomy	14 (31.8)	7 (25)	7 (43.8)
Superior polar gastrectomy	4 (9.1)	4 (14.3)	0
Reconstruction after STG
Roux-en-Y	19 (73.1)	12 (70.6)	7 (77.8)	0.69
Billroth II	7 (26.9)	5 (29.4)	2 (22.2)
Clavien-Dindo ≥ 3
	4 (9.1)	4 (14.3)	0	0.11
Fecal elastase (mcg/g), median (QR)
	343.5 (157-513.75)	476 (345.75-631.75)	120.5 (52.75-194.5)	< 0.0001
Histotype
Intestinal	23 (52.3)	16 (57.1)	7 (43.7)	0.08
Diffuse	11 (25)	7 (25)	4 (25)
Mixed	10 (22.7)	5 (17.9)	5 (31.3)
T stage
T1-T2	18 (40.9)	14 (50)	4 (25)	0.1
T3-T4	26 (59.1)	14 (50)	12 (75)
N stage
N0	19 (43.2)	14 (50)	5 (31.3)	0.23
N+	25 (56.8)	14 (50)	11 (68.7)
Adjuvant therapy
	24 (54.5)	14 (50)	10 (62.5)	0.42
Tumor recurrence
	11 (25)	5 (19.2)	6 (37.5)	0.19

ASA: American Society of Anesthesiologists; EPI: Exocrine pancreatic insufficiency; STG: Subtotal gastrectomy.

Table 2 Comparative analysis of clinico-demographic characteristics according to exocrine pancreatic insufficiency severity, n (%)

Variables	No-EPI (n = 28)	Moderate EPI (n = 9)	Severe EPI (n = 7)	P value
Sex
Male	16 (57.1)	7 (77.8)	4 (57.1)	0.35
Female	12 (42.9)	2 (22.2)	3 (42.9)
Age
≥ 65	16 (57.1)	8 (88.9)	2 (28.6)	0.05
< 65	12 (42.9)	1 (11.1)	5 (71.4)
Comorbidities
Diabetes	3 (10.7)	2 (22.2)	2 (28.6)	0.32
Cardiovascular disease	6 (21.4)	3 (33.3)	2 (28.6)
Pulmonary disease	2 (7.1)	3 (33.3)	2 (28.6)
ASA score
ASA 1	0	0	0	0.4
ASA 2	22 (78.6)	7 (77.8)	7 (100)
ASA 3	6 (21.4)	2 (22.2)	0
Tumor location
Proximal	10 (35.7)	1 (11.1)	3 (42.9)	0.41
Middle	3 (10.7)	3 (33.3)	1 (14.2)
Distal	15 (53.6)	5 (55.6)	3 (42.9)
Neoadjuvant therapy
	14 (50)	5 (55.6)	6 (85.7)	0.23
Type of surgical procedure
STG	17 (60.7)	5 (55.6)	4 (57.1)	0.49
Total gastrectomy	7 (25)	4 (44.4)	3 (42.9)
Superior polar gastrectomy	4 (14.3)	0	0
Reconstruction after STG
Roux-en-Y	12 (70.6)	4 (80)	3 (75)	0.91
Billroth II	5 (29.4)	1 (20)	1 (25)
Clavien-Dindo ≥ 3
	4 (14.3)	0	0	0.28
Fecal elastase (mcg/g), median (QR)
	476 (347.5-620.5)	184 (137-218)	47 (15-95)	< 0.0001
Histotype
Intestinal	16 (57)	7 (77.8)	0	0.02
Diffuse	7 (25)	1 (11.1)	3 (42.9)
Mixed	5 (18)	1 (11.1)	4 (57.1)
T stage
T1-T2	14 (50)	4 (44.4)	0	0.05
T3-T4	14 (50)	5 (55.6)	7 (100)
N stage
N0	14 (50)	5 (55.6)	0	0.04
N+	14 (50)	4 (44.4)	7 (100)
Adjuvant therapy
	14 (50)	4 (44.4)	6 (85.7)	0.19
Tumor recurrence
	5 (17.8)	2 (22.2)	4 (57.1)	0.12

ASA: American Society of Anesthesiologists; EPI: Exocrine pancreatic insufficiency; QR: Quartile rank; STG: Subtotal gastrectomy.

Table 3 Gastrointestinal Quality of Life Index score according to the clinico-demographic characteristics and exocrine pancreatic insufficiency severity of the study population, n (%)

Variables	Study population (n = 44)	Gastrointestinal Quality of Life Index, median (QR)	P value
Sex
Male	26 (59.1)	85 (76-96)	0.68
Female	18 (40.9)	90 (72-94)
Age
≥ 65	26 (59.1)	83 (66-90)	0.25
< 65	18 (40.9)	90 (76-96)
ASA score
ASA 1	0	0	0.3
ASA 2	36 (81.8)	86 (76-90)
ASA 3	8 (18.2)	93 (66-110)
Neoadjuvant therapy
Yes	25 (56.8)	90 (89-100)	0.23
No	19 (43.2)	85 (72-95)
Type of surgical procedure
STG	26 (59.1)	90 (76-96)	0.53
Total gastrectomy	14 (31.8)	81 (66-95)
Superior polar gastrectomy	4 (9.1)	83 (65-95)
Reconstruction after STG
Roux-en-Y	19 (73.1)	90 (89-96)	0.61
Billroth II	7 (26.9)	79 (76-106)
Clavien-Dindo
≥ 3	4 (9.1)	86 (76-94)	0.82
< 3	40 (90.9)	90 (90-113)
Histotype
Intestinal	23 (52.3)	80 (76-96)	0.6
Diffuse	11 (25)	95 (66-126)
Mixed	10 (22.7)	86 (62-107)
T stage
T1-T2	18 (40.9)	87 (76-95)	0.47
T3-T4	26 (59.1)	88 (71-94)
N stage
N0	19 (43.2)	85 (76-95)	0.41
N+	25 (56.8)	90 (85-105)
EPI
Yes	16 (36.4)	78 (75-106)	0.52
No	28 (63.6)	85 (73-96)
EPI severity
No/moderate	37 (84.1)	89 (84-100)	0.002
Severe	7 (15.9)	65 (59-92)

ASA: American Society of Anesthesiologists; EPI: Exocrine pancreatic insufficiency; QR: Quartile rank; STG: Subtotal gastrectomy.

Table 4 Gastrointestinal Quality of Life Index domains analysis according to exocrine pancreatic insufficiency severity

Gastrointestinal Quality of Life Index domains	No-EPI/moderate EPI (n = 37)	Severe EPI (n = 7)	P value
Gastrointestinal symptoms, median (QR)
Core symptoms	23 (22-26)	13 (12-18)	< 0.0001
Disease-specific symptoms	34 (33-36)	28 (23-36)	0.002
Physical conditions, median (QR)	10 (9-13)	14 (12-17)	0.06
Emotional conditions, median (QR)	13 (12-15)	10 (10-16)	1
Social setting, median (QR)	10 (9-13)	13 (6-16)	0.58

EPI: Exocrine pancreatic insufficiency; QR: Quartile rank.