Can a person who has undergone a distal pancreatectomy (surgical removal of the distal portion of the pancreas) expect to eat normally again?

From the Guidelines

Most patients who undergo a distal pancreatectomy can expect to eat normally again, although the recovery process and potential for long-term digestive issues vary widely among individuals. The available evidence suggests that while some patients may experience recurrent or ongoing mild symptoms, others may have complete symptom resolution or only occasional symptoms after surgery 1. For example, a retrospective study of patients who underwent distal pancreatectomy found that 2 patients had complete symptom resolution, 3 had occasional symptoms, and 2 had frequent symptoms 1. It's also important to note that the extent of pancreatic resection can impact the likelihood of long-term digestive issues, with more extensive resections potentially leading to a higher risk of complications such as diabetes and exocrine pancreatic insufficiency 1. In terms of management, patients often work with dietitians to develop personalized nutrition plans during recovery, which may involve smaller, more frequent meals that are lower in fat, as well as potential enzyme supplements to aid digestion 1. Overall, while the outcome can vary, the majority of patients can expect to return to a normal diet after a distal pancreatectomy, with some potential for long-term digestive issues that can be managed with appropriate medical care and dietary modifications. Key considerations for patients undergoing distal pancreatectomy include:

• The potential for temporary digestive issues such as diarrhea, gas, or bloating as their body adjusts to the surgery
• The risk of developing diabetes or exocrine pancreatic insufficiency, particularly if a large portion of the pancreas is removed
• The importance of working with a dietitian to develop a personalized nutrition plan during recovery
• The potential need for long-term dietary modifications or supplements to manage digestive issues.

From the FDA Drug Label

1. 2 Exocrine Pancreatic Insufficiency Due to Chronic Pancreatitis or Pancreatectomy A randomized, double-blind, placebo-controlled, parallel group study was conducted in 54 adult patients, aged 32 to 75 years, with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatectomy (Study 4) The final analysis population was limited to 52 patients; 2 patients were excluded due to protocol violations. Ten patients had a history of pancreatectomy (7 were treated with CREON) The remaining 6 patients with a history of partial pancreatectomy treated with CREON on the study had a mean CFA of 42% during the run-in period and a mean CFA of 84% at the end of the double-blind period

A person who has undergone a distal pancreatectomy may be able to eat normally again with the help of pancreatic enzyme replacement therapy, such as CREON.

• The study showed that patients with a history of partial pancreatectomy who were treated with CREON had a significant improvement in coefficient of fat absorption (CFA), from a mean of 42% to 84% 2.
• However, it is essential to note that the study had a limited number of patients with a history of pancreatectomy, and individual results may vary.
• Patients with exocrine pancreatic insufficiency due to pancreatectomy may require ongoing enzyme replacement therapy to manage their condition and maintain adequate nutrition.

From the Research

Post-Distal Pancreatectomy Diet

• Patients who have undergone a distal pancreatectomy may experience pancreatic exocrine insufficiency, which can lead to malnutrition and maldigestion 3, 4.
• The incidence of pancreatic exocrine insufficiency after distal pancreatectomy can range from 12-80% 3.
• Patients who have had a distal pancreatectomy may need to take pancreatic enzyme replacement therapy to help with digestion and nutrient absorption 3, 4, 5.
• With proper treatment, including pancreatic enzyme replacement therapy, patients can recover from malnutrition and achieve a normal diet 4.
• Some studies have shown that patients who undergo distal pancreatectomy can resume a normal diet earlier, with one study showing that patients resumed a normal diet at a median of 4 days after surgery 6.

Factors Affecting Diet After Distal Pancreatectomy

• The extent of the surgery, the health of the residual pancreas, and the type of reconstruction can affect the patient's ability to eat normally after distal pancreatectomy 3.
• Patients who undergo extensive resection are more likely to experience pancreatic exocrine insufficiency and may need individualized assessment and treatment 3.
• The use of laparoscopic technique and the presence of concomitant major organ resection can also affect the patient's recovery and ability to eat normally after distal pancreatectomy 6.

Treatment and Management

• Pancreatic enzyme replacement therapy can be effective in treating pancreatic exocrine insufficiency and improving nutritional status after distal pancreatectomy 3, 4, 5.
• Patients who do not respond to pancreatic enzyme replacement therapy may need to be referred to a specialist dietitian and undergo further investigation to exclude other gastrointestinal pathology 3.
• Treatment with pancrelipase has been shown to be effective in improving hepatic steatosis after pancreatectomy, with a cumulative improvement rate of 92% after 1 year of treatment 5.