Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Selection Criteria and Data Extraction
2.3. Quality Assessment
3. Results
3.1. Literature Research
3.2. Study Characteristics
3.3. Nutritional Status at Presentation
3.4. Nutritional Status at Time of Resection
3.5. Nutritional Support
4. Discussion
4.1. Nutritional Deficiencies in Pancreatic Adenocarcinoma Presentation
4.1.1. Weight Loss & Biochemical Markers
4.1.2. Pancreatic Exocrine Insufficiency (PEI)
4.1.3. Pancreatic Endocrine Insufficiency
4.2. Post-surgical Changes in Nutritional Status
4.2.1. Biochemical Markers
4.2.2. Vitamin Deficiencies
4.2.3. Exocrine Insufficiency
4.2.4. Endocrine Insufficiency
4.3. Nutritional Support
4.3.1. Total Parenteral Nutrition vs. Enteral Nutrition
4.3.2. Immunomodulating Enteral Nutrition
4.3.3. Total Parenteral Nutrition
4.3.4. Eicosapentaenoic Acid Supplementation
4.3.5. Use of Feeding Tubes Postoperatively
5. Conclusions
Conflicts of Interest
Abbreviations
QOL | quality of life |
PEI | pancreatic exocrine insufficiency |
PNETs | pancreatic neuroendocrine tumors |
PDAC | pancreatic adenocarcinoma |
PD | pancreaticoduodenectomy |
DP | distal pancreatectomy |
TPN | total parenteral nutrition |
DM | diabetes mellitus |
PNI | Prognostic Nutrition Index |
MUST | Malnutrition Universal Screen Tool |
SSI | surgical site infections |
NODM | New onset diabetes mellitus |
3c DM | pancreatogenic diabetes |
SMA | superior mesenteric artery |
EN | enteral nutrition |
BMI | body mass index |
SGA | Subjective Global Assessment |
EPA | eicosapentaenoic acid |
REE | resting energy expenditure |
FJT | feeding jejunostomy tubes |
NJEEN | nasojejunal early enteral nutrition |
NJT | naso-jejunal tube |
POPF | postoperative pancreatic fistula |
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Preoperative Nutrition Evaluation | Nutritional Intervention | Postoperative Nutritional Parameters to Follow |
---|---|---|
Albumin < 2.5 mg/dL or Weight Loss > 10% | Postpone surgery date. Begin aggressive nutrition supplementation Consider feeding jejunostomy tube (FJT) placement intraoperatively | Required: Hemoglobin A1c or Oral Glucose Tolerance Test (OGTT), Albumin, Fecal Elastase, and Vitamin B12 Recommended: Zinc, Iron, Vitamin A, Vitamin E, 25-OH-vitamin D3 and fecal fat |
Weight Loss 5%–10% or Albumin < 3 mg/dL | Nutrition supplementation prior to surgery Consider FJT placement intraoperatively |
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Gilliland, T.M.; Villafane-Ferriol, N.; Shah, K.P.; Shah, R.M.; Tran Cao, H.S.; Massarweh, N.N.; Silberfein, E.J.; Choi, E.A.; Hsu, C.; McElhany, A.L.; et al. Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection. Nutrients 2017, 9, 243. https://doi.org/10.3390/nu9030243
Gilliland TM, Villafane-Ferriol N, Shah KP, Shah RM, Tran Cao HS, Massarweh NN, Silberfein EJ, Choi EA, Hsu C, McElhany AL, et al. Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection. Nutrients. 2017; 9(3):243. https://doi.org/10.3390/nu9030243
Chicago/Turabian StyleGilliland, Taylor M., Nicole Villafane-Ferriol, Kevin P. Shah, Rohan M. Shah, Hop S. Tran Cao, Nader N. Massarweh, Eric J. Silberfein, Eugene A. Choi, Cary Hsu, Amy L. McElhany, and et al. 2017. "Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection" Nutrients 9, no. 3: 243. https://doi.org/10.3390/nu9030243