1. Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection
- Author
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Rohan M. Shah, Eric J. Silberfein, Omar Barakat, Amy L. McElhany, Taylor M. Gilliland, Nader N. Massarweh, George Van Buren, William E. Fisher, Nicole Villafane-Ferriol, Eugene Choi, Hop S. Tran Cao, Kevin P. Shah, and Cary Hsu
- Subjects
medicine.medical_specialty ,Databases, Factual ,Non-Randomized Controlled Trials as Topic ,medicine.medical_treatment ,Nutritional Status ,lcsh:TX341-641 ,Review ,malnutrition ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Metabolic Diseases ,pancreas cancer ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,enteral nutrition ,distal pancreatectomy ,Exocrine pancreatic insufficiency ,Pancreas ,Randomized Controlled Trials as Topic ,pancreatic exocrine insufficiency ,Nutrition and Dietetics ,business.industry ,Nutritional Support ,General surgery ,Cancer ,Perioperative ,medicine.disease ,pancreatogenic diabetes ,Steatorrhea ,pancreas adenocarcinoma ,Pancreatic Neoplasms ,Parenteral nutrition ,medicine.anatomical_structure ,nutrition ,030220 oncology & carcinogenesis ,Pancreatectomy ,diabetes mellitus ,Quality of Life ,030211 gastroenterology & hepatology ,medicine.symptom ,pancreaticoduodenectomy ,business ,lcsh:Nutrition. Foods and food supply ,Biomarkers ,Food Science - Abstract
Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995–2016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin < 2.5 mg/dL or weight loss > 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin < 3 mg/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient’s quality of life.
- Published
- 2017