Postpancreatectomy diarrhoea: prospective, single-centre longitudinal analysis of incidence, risk factors, management, and impact on quality of life

TL;DR

This study shows that postpancreatectomy diarrhoea affects over a third of patients, even with enzyme therapy, and is linked to worse quality of life and specific surgical and disease factors.

Contribution

The study prospectively identifies risk factors and management needs for postpancreatectomy diarrhoea, emphasizing personalized care.

Findings

Postpancreatectomy diarrhoea affects 32-41% of patients at different postoperative time points.

Vascular resection, arterial divestment, and pancreatic ductal adenocarcinoma are independent risk factors for severe diarrhoea.

Distal pancreatectomy is protective against moderate-to-severe postpancreatectomy diarrhoea.

Abstract

Postpancreatectomy diarrhoea significantly impairs outcomes and patient’s quality of life. Its origin is multifactorial, extending beyond exocrine pancreatic insufficiency. Even with pancreatic enzyme replacement therapy, persistent postpancreatectomy diarrhoea can lead to malnutrition and inhibit adjuvant treatments. This study aimed to evaluate the incidence, risk factors, management, and impact of postpancreatectomy diarrhoea on quality of life.

This prospective longitudinal study enrolled patients undergoing pancreatectomy at a single tertiary centre from 2023 to 2025. After surgery (at 7, 30, and 90 days), an adapted systemic therapy-induced diarrhoea assessment tool (STIDAT) questionnaire was used to assess for the presence of postpancreatectomy diarrhoea, patient-reported severity, frequency, medication use, associated symptoms, and quality of life.

A total of 237 patients were included (pancreatoduodenectomy 54%, distal pancreatectomy 35%, total pancreatectomy 11%). Overall, the incidence of postpancreatectomy diarrhoea was 32, 41, and 33% at 7, 30, and 90 days, respectively. Postpancreatectomy diarrhoea was most frequent and severe after total pancreatectomy and pancreatoduodenectomy (62 and 50% at 30 days) and least after distal pancreatectomy (22.0% at 30 days) (P < 0.001). The severity of postpancreatectomy diarrhoea correlated with worse quality of life and higher STIDAT scores at all time points. Most patients with postpancreatectomy diarrhoea required pancreatic enzyme replacement therapy, with a median dose of 85 000 lipase units per day by 90 days, and up to 37% also needed antidiarrhoeals. Common 30-day symptoms included urgency (52%), abdominal discomfort (69.4%), and incontinence (18.4%). In multivariable analysis, pancreatic ductal adenocarcinoma, vascular resection, and arterial divestment were independent predictors of moderate-to-severe postpancreatectomy diarrhoea, whereas distal pancreatectomy was protective.

Postpancreatectomy diarrhoea is an impactful complication after pancreatectomy, affecting more than one-third of patients even after correct pancreatic enzyme replacement therapy. Patients undergoing vascular resection and arterial divestment are at higher risk of severe postpancreatectomy diarrhoea, and require tailored postoperative management to reduce its negative effects, which include impaired quality of life.

Postpancreatectomy diarrhoea affects over one-third of patients despite appropriate enzyme replacement, significantly impairing quality of life. This prospective study identified key risk factors for moderate-to-severe diarrhoea, including vascular resection, arterial divestment, and pancreatic ductal adenocarcinoma aetiology. The study findings highlight the need for personalized postoperative management to mitigate the clinical and therapeutic impact of postpancreatectomy diarrhoea.

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