Abstract
This thesis explored the long-term management of patients undergoing pancreaticoduodenectomy (PD) – a complex surgical operation for the treatment of benign, pre-malignant and malignant disease of the periampullary region (i.e., pancreas, duodenum and distal common bile duct).
This operation results in a multitude of digestive consequences with long-term health consequences, and an impact on quality-of-life (QoL).
Initially, an exploration of the literature explained the mechanisms behind changes in digestion after PD (Chapter 1), and two systematic reviews identified the deteriorating nutritional status in pancreatic malignancy and highlighted positive outcomes from nutritional intervention in benign disease (Chapter 2).
A survey of practice across the United Kingdom confirmed poor follow-up services with geographical variation (Chapter 3).
A retrospective review of clinical outcomes in 184 consecutive patients undergoing PD identified the negative impact of obesity and sarcopenic obesity, and demonstrated Hand Grip Strength was the only nutritional marker correlated with muscle mass (Chapter 4).
Micronutrient status was explored retrospectively in 205 patients after PD, concluding that Vitamin D, Zinc and Iron depletion was prevalent despite supplementation. A narrative literature review supported recommendations on the content of biochemical assessment after PD (Chapter 5).
A prospective, observational, pilot study after PD was undertaken to assess the use of validated questionnaires, step counters, rectus femoris muscle ultrasound and dietary intake assessment, and identified poor oral intake, physical activity levels whilst highlighting the acceptability of step counters as a marker of physical activity (Chapter 6).
Finally, a prospective and retrospective combined observational trial analysed longer-term outcomes and identified that consequences occurred in 82% of patients: 30% at a surgical anastomosis, >50% developed diabetes, 74% had reduced bone density, and QoL indicators were good when holistic support was provided (Chapter 7).
In summary, this thesis makes recommendations for long-term multi-disciplinary follow-up after PD and provides suggestions for further research.