Long-term changes in body composition after pancreaticoduodenectomy

Background: The Whipple's procedure (WP) is a major operation that adds a further demand on the body's nutritional reserves and therefore body composition after the effect of pancreatic cancer. The aim was to document changes in body composition changes that occur during the first six months after a WP for a pancreatic cancer malignancy. Methods: Twenty-seven (14 males, 13 females) consecutive WP patients had body composition measured at baseline and then at 2, 5, 14 and 26 weeks after surgery. These included; anthropometric measure (weight, skin folds and arm muscle area (AMA)), total body measures of protein (TBP), potassium (TBK), water (TBW) and fat mass (FM). Changes were compared using repeated measures analysis of variance. Results: Hospital nutritional care maintained TBP and TBK but at 2 weeks there was a loss of FM (P = 0.037). The nadir of weight loss (P < 0.001) occurred at 5 weeks because of losses of protein (P = 0.007), fat (P < 0.001) and potassium (P = 0.045) but not water. Although weight and FM were still significantly less than baseline measures at 26 weeks weight, TBP, TBK and AMA were not significantly different to preoperative values. Conclusions: Although at 6 months, important measures of the metabolically functioning tissue, TBP and TBK, have returned to preoperative values significant losses occurred during the first 3 weeks after discharge from hospital and FM did not return to preoperative values. These results suggest the need to improve post-discharge nutritional care.