Effects of rikkunshito administration after distal pancreatectomy on postoperative oral intake and weight loss

Table 1 Baseline characteristics of patients, n (%)

	RT (-) (n = 124)	RT (+) (n = 117)	P value
Age, years, median (IQR)	65 (53-73)	71 (55-78)	0.006
Sex, male/female	73 (58.9)/51 (41.1)	59 (50.4)/58 (49.6)	0.198
Height, cm, mean ± SD	160.2 ± 8.7	159.7 ± 8.9	0.638
Weight, kg, mean ± SD	57.44 ± 11.33	58.48 ± 12.33	0.496
Body mass index, kg/m2, mean ± SD	22.2 ± 3.6	22.8 ± 4.2	0.258
Underlying disease			0.230
PDAC	57 (46.0)	55 (46.6)
IPMN	31 (25.0)	30 (25.4)
NET	4 (3.2)	9 (7.6)
Chronic pancreatitis	8 (6.5)	11 (9.3)
Others	24 (19.4)	13 (11.0)
Postoperative complication
Clavien-Dindo grade ≥ IIIa	22 (17.7)	20 (17.1)	1.00
Pancreatic fistula (Grade B or C)	14 (11.3)	8 (6.8)	0.232
Delayed gastric emptying	2 (1.6)	2 (1.7)	1.00

Baseline demographic and clinical characteristics were compared between the rikkunshito (RT) (-) group (n = 124) and the RT (+) group (n = 117). Variables included age, sex, height, weight, body mass index, underlying disease, major postoperative complications (Clavien-Dindo grade ≥ IIIa), postoperative pancreatic fistula (Grade B or C), and delayed gastric emptying. RT: Rikkunshito; PDAC: Pancreatic ductal adenocarcinoma; IPMN: Intraductal papillary mucinous neoplasm; NET: Neuroendocrine tumor; IQR: Interquartile range.

Table 2 Oral intake on postoperative day 7

	RT (-) (n = 124)	RT (+) (n = 117)	P value
Time to start liquid intake	1 (1-1)	1 (1-1)	-
Time to start oral intake	3 (3-3)	3 (3-3)	-
Breakfast main dish, %	55 (7.5-100)	80 (50-100)	0.007
Side dish, %	50 (10-100)	80 (50-100)	< 0.001
Lunch main dish, %	50 (20-100)	80 (40-100)	0.043
Side dish, %	60 (20-100)	90 (50-100)	0.006
Dinner main dish, %	50 (7.5-100)	80 (20-100)	0.063
Side dish, %	50 (17.5-100)	90 (50-100)	0.001

Oral intake on postoperative day 7 was compared between the rikkunshito (RT) (-) group (n = 124) and the RT (+) group (n = 117). The times to initiation of liquid intake and oral intake were identical in the two groups. Liquid intake was initiated on postoperative day 1 and oral intake on postoperative day 3 in all patients according to the institutional clinical pathway. Intake was evaluated for each component of the meal, which included the breakfast main dish, breakfast side dish, lunch main dish, lunch side dish, dinner main dish, and dinner side dish. Oral intake was expressed as the percentage of the provided meal consumed. Values are presented as medians (interquartile range). Continuous variables were compared using the Mann-Whitney U test. RT: Rikkunshito.

Table 3 Changes in body weight

	RT (-) (n = 124)	RT (+) (n = 117)	P value
Preoperative, kg	57.44 ± 11.33	58.48 ± 12.33	0.496
1 month postoperatively, kg	54.76 ± 10.87	56.45 ± 11.45	0.240
Weight loss, kg	-2.65 (-4.32 to -0.87)	-2.00 (-3.70 to -0.20)	0.044

Preoperative body weight, body weight at 1 month postoperatively, and postoperative weight loss were compared between the rikkunshito (RT) (-) group (n = 124) and the RT (+) group (n = 117). Preoperative body weight and body weight at 1 month postoperatively are presented as mean ± SD, whereas body weight loss values are presented as median (interquartile range). Weight loss is expressed as a negative value. Comparisons between groups were performed using the student t-test or the Mann-Whitney U test depending on distributions of data. RT: Rikkunshito.

Table 4 Multivariable linear regression analysis for postoperative body weight loss

Variable	Coefficient (β)	95%CI	P value
RT (+)	-0.77	-1.39 to -0.15	0.015
Age	-0.01	-0.02 to 0.01	0.388
Body mass index	0.20	0.12 to 0.28	< 0.001
Clavien-Dindo grade ≥ IIIa	0.78	-0.03 to 1.59	0.059

Multivariable linear regression analysis was performed to identify factors associated with postoperative body weight loss at 1 month after distal pancreatectomy. Variables included in the model were rikkunshito administration, age, preoperative body mass index, and major postoperative complications (Clavien-Dindo grade ≥ IIIa). RT: Rikkunshito; CI: Confidence interval.