Original Paper

Pancreaticoduodenectomy for Peri-Ampullary Neoplasia Leads to Specific Micronutrient Deficiencies
T. Armstrong^a, L. Strommer^c, F. Ruiz-Jasbon^d, F.W. Shek^a, S.F. Harris^b, J. Permert^c, C.D. Johnson<sup>a

a</sup>University Department of Surgery and
^bPublic Health Sciences/Medical Statistics, Southampton General Hospital, Southampton, UK;
^cCentre for Surgical Sciences, Karolinska University Hospital, Huddinge, Stockholm, and
^dKirurg Kliniken, Sahlgrenska University Hospital, Mölndal, Sweden

Address of Corresponding Author

Pancreatology 2007;7:37-44 (DOI: 10.1159/000101876)

  Key Words

• Pancreaticoduodenectomy
• Whipple's procedure
• Nutrition
• Micronutrients
• Iron

  Abstract

Background/Aims: After pancreaticoduodenectomy (PD) patients may be deficient in essential micronutrients. This study was designed to determine if this is a consequence of surgery. Methods: Long-term survivors (>6 months) of PD for peri-ampullary neoplasia and healthy controls (patients' spouse/partner) were enrolled in the study. Specific clinical parameters were recorded, serum micronutrient levels were measured and subjects completed 7-day food diaries. Results: Thirty-seven patients were studied, 25 with paired controls. All were well nourished, as defined by body mass index and food diary analysis. Patients with paired controls were representative of all patients studied. Patients had raised transferrin (median 2.60 vs. 2.16 g/l, p = 0.001) and low ferritin levels (34.9 vs. 119.0 g/l, p < 0.001) indicating relative iron deficiency. Patients also demonstrated lower levels of the anti-oxidants selenium (0.77 vs. 0.93 µmol/l, p < 0.001) and vitamin E (23.2 vs. 35.7 µmol/l, p < 0.001) with 57% of patients having frank selenium deficiencies. Patients had lower levels of vitamin D than controls (15.7 vs. 19.6 µmol/l, p = 0.001) and 30% of patients had a raised parathyroid hormone level, suggesting compensatory mechanisms operate to maintain normocalcaemia. Conclusions: Long-term survivors of PD are relatively deficient in several micronutrients compared to non-operated controls taking the same diet. We recommend that micronutrient status should be regularly checked in these patients and treated where necessary.

Copyright © 2007 S. Karger AG, Basel and IAP

  Author Contacts

Mr. T. Armstrong
University Department of Surgery, Mailpoint 816
Southampton General Hospital, Tremona Road, Southampton, SO16 6YD (UK)
Tel. +44 23 8079 6145, Fax +44 23 8079 4020
E-Mail armstrongthomas@talk21.com

  Article Information

Preliminary results of this work were presented to the Pancreatic Society of Great Britain and Ireland in 2003 [Pancreatology 2003;3:538] and the Association of Upper Gastrointestinal Surgeons 2004 (abstract not published).

Received: July 6, 2006
Accepted: September 20, 2006
Published online: April 18, 2007
Number of Print Pages : 8
Number of Figures : 4, Number of Tables : 6, Number of References : 17