Importance of Pancreatic Enzyme Replacement Therapy after Surgery of Cancer of the Esophagus or the Esophagogastric Junction

ABSTRACT

After surgical treatment of cancer of the esophagus or the esophagogastric junction we observed steatorrhea, which is so far seldom reported. We analyzed all patients treated in our rehabilitation clinic between 2011 and 2014 and focused on the impact of surgery on digestion of fat. Reported steatorrhea was anamnestic, no pancreatic function test was made. Here we show the results from 51 patients. Twenty-three (45%) of the patients reported steatorrhea. Assuming decreased pancreatic function pancreatic enzyme replacement therapy (PERT) was started or modified during the rehabilitation stay (in the following called STEA⁺). These patients were compared with the patients without steatorrhea and without PERT (STEA⁻). Maximum weight loss between surgery and rehabilitation start was 18 kg in STEA⁺ patient and 15.3 kg in STEA⁻ patients. STEA⁺ patients gained more weight under PERT during the rehabilitation phase (3 wk) than STEA⁻ patients without PERT (+1.0 kg vs. −0.3 kg, P = 0.032). We report for the first time, that patients after cancer related esophageal surgery show anamnestic signs of exocrine pancreas insufficiency and need PERT to gain body weight.

Acknowledgments

This trial was funded by an institutional grant of the Department of Medical Oncology of the Klinik am See, Rüdersdorf, Berlin. All authors drafted, read, and approved the final version of the manuscript.