Abstract
Cachexia, malnutrition, significant weight loss, and reduction in food intake due to anorexia represent the most important pathophysiological consequences of pancreatic cancer. Pathophysiological consequences result also from pancreatectomy, the type and severity of which differ significantly and depend on the type of the operation performed. Nutritional intervention, either parenteral or enteral, needs to be seen as a method of support in pancreatic cancer patients aiming at the maintenance of the nutritional and functional status and the prevention or attenuation of cachexia. Oral nutrition could reduce complications while restoring quality of life. Enteral nutrition in the post-operative period could also reduce infective complications. The evidence for immune-enhanced feed in patients undergoing pancreaticoduodenectomy for pancreatic cancer is supported by the available clinical data. Nutritional support during the post-operative period on a cyclical basis is preferred because it is associated with low incidence of gastric stasis. Postoperative total parenteral nutrition is indicated only to those patients who are unable to be fed orally or enterally. Thus nutritional deficiency is a relatively widesoread and constant finding suggesting that we must optimise the nutritional status both before and after surgery.
Similar content being viewed by others
References
Rocha-Lima CM (2008) New directions in the management of advanced pancreatic cancer: a review. Anticancer Drugs 19:435–446
Bozzetti F (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17:279–284
Ockenga J, Valentini L (2005) Review article: anorexia and cachexia in gastrointestinal cancer. Aliment Pharmacol Ther 22:583–594
Uomo G, Gallucci F, Rabitti PG (2006) Anorexia-cachexia syndrome in pancreatic cancer: recent development in research and management. JOP 7:157–162
Di Luzio R, Moscatiello S, Marchesini G (2010) Role of nutrition in gastrointestinal oncological patients. Eur Rev Med Pharmacol Sci 14:277–284
Bachmann J, Heiligensetzer M, Krakowski-Roosen H, Büchler MW, Friess H, Martignoni ME (2008) Cachexia worsens prognosis in patients with resectable pancreatic cancer. J Gastrointest Surg 12:1193–1201
Bachmann J, Ketterer K, Marsch C, Fechtner K, Krakowski-Roosen H, Büchler MW, Friess H, Martignoni ME (2009) Pancreatic cancer related cachexia: influence on metabolism and correlation to weight loss and pulmonary function. BMC Cancer 9:255
Raghu Dhanapal R, Saraswathi TR, Rajkumar N, Govind RN (2011) Cancer cachexia. J Oral Maxillofac Pathol 15:257–260
Ramos EJ, Suzuki S, Marks D, Inui A, Asakawa A, Meguid MM (2004) Cancer anorexia-cachexia syndrome: cytokines and neuropeptides. Curr Opin Clin Nutr Metab Care 7:427–434
Legakis I, Stathopoulos J, Matzouridis T, Stathopoulos GP (2009) Decreased plasma ghrelin levels in patients with advanced cancer and weight loss in comparison to healthy individuals. Anticancer Res 29:3949–3952
Banks WA (2001) Anorectic effects of calculating cytokines: role of the vascular blood-brain barrier. Nutrition 17:434–437
Karayiannakis AJ, Syrigos KN, Polychronidis A, Pitiakoudis M, Bounovas A, Simopoulos K (2001) Serum levels of tumor necrosis factor-alpha and nutritional status in pancreatic cancer patients. Anticancer Res 21(2B):1355–1358
Argilés JM, Busquets S, García-Martínez C, López-Soriano FJ (2005) Mediators involved in the cancer anorexia-cachexia syndrome: past, present, and future. Nutrition 21:977–985
Durham WJ, Dillon EL, Sheffield-Moore M (2009) Inflammatory burden and amino acid metabolism in cancer cachexia. Curr Opin Clin Nutr Metab Care 12:72–77
Tisdale MJ (2009) Mechanism of cancer cachexia. Physiol Rev 89:381–410
Coss CC, Bohl CE, Dalton JT (2011) Cancer cachexia therapy: a key weapon in the fight against cancer. Curr Opin Clin Nutr Metab Care 14:268–273
Takaki M (2003) Gut pacemaker cells: the intestinal cells of Cajal (ICC). J Smooth Muscle Res 39:137–161
Martignoni ME, Friess H, Sell F, Ricken L, Shrikhande S, Kulli C, Büchler MW (2000) Enteral nutrition prolongs delayed gastric emptying in patients after Whipple resection. Am J Surg 180:18–23
Ishikawa O (1996) Surgical technique, curability and postoperative quality of life in an extended pancreatectomy for adenocarcinoma of the pancreas. Hepatogastroenterology 43:320–325
Chang EB (1986) Experimental diabetic diarrhea in rats. Intestinal mucosal denervation hypersensitivity and therapy with clonidine. Gastroenterology 91:564–569
Chang EB, Bergenstal RM, Field M (1985) Diarrhea in streptozocin-treated rats. Loss of adrenergic regulation of intestinal fluid and electrolyte transport. J Clin Invest 75:1666–1670
Pappas S, Krzywda E, McDowell N (2010) Nutrition and pancreaticoduodenectomy. Nutr Clin Pract 25:234–243
Seeman E, Melton U III, O’Fallon WM, Riggs BL (1983) Risk factors for spinal osteoporosis in men. Am J Med 75:977–983
Bajorunas DR, Fortner JG, Jaspan J, Sherwin RS (1986) Total pancreatectomy increases the metabolic response to glucagon in humans. J Clin Endocrinol Metab 63:439–446
Frey CF, Child CG, Fry W (1976) Pancreatectomy for chronic pancreatitis. Ann Surg 184:403–414
Del Prato S, Tiengo A, Baccaglini U et al (1983) Effect of insulin replacement on intermediary metabolism in diabetes secondary to pancreatectomy. Diabetologia 25:252–259
Jarvinen HY, Kiviluoto T, Taskinen MR (1986) Insulin resistance is a prominent feature of patients with pancreatogenic diabetes. Metabolism 35:718–727
Bajorunas DR, Dresler CM, Horowitz GD et al (1986) Basal glucagon replacement in chronic glucagon deficiency increases insulin resistance. Diabetes 35:556–562
Bajorunas DR, Fortner JG, Jaspan JB (1986) Glucagon immunoreactivity and chromatographic profiles in pancreatectomized humans: paradoxical response to oral glucose. Diabetes 35:886–893
Bennett LL (1983) What causes fatty liver after pancreatectomy-an unresolved and forgotten controversy? Perspect Biol Med 26:595–612
Kunze WA, Furness JB (1999) The enteric nervous system and regulation of intestinal motility. Annu Rev Physiol 61:117–142
Van Citters GW, Lin HC (2006) Ileal brake: neuropeptidergic control of intestinal transit. Curr Gastroenterol Rep 8:367–373
Naruse S, Kitagawa M, Ishiguro H et al (2002) Feedback regulation of pancreatic secretion by peptide YY. Peptides 23:359–365
Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, Matsumoto J (2010) Postoperative bowel function and nutritional status following distal pancreatectomy with en-bloc celiac axis resection. Dig Surg 27:212–216
Shikano T, Nakao A, Kodera Y, Yamada S, Fujii T, Sugimoto H, Kanazumi N, Nomoto S, Takeda S (2010) Middle pancreatectomy: safety and long-term results. Surgery 147:21–29
Jang JY, Kim SW, Han JK, Park SJ, Park YC, Joon Ahn Y, Park YH (2003) Randomized prospective trial of the effect of induced hypergastrinemia on the prevention of pancreatic atrophy after pancreatoduodenectomy in humans. Ann Surg 237:522–529
Sugiyama M, Atomi Y (2000) Pylorus-preserving total pancreatectomy for pancreatic cancer. World J Surg 24:66–70
Kawai M, Tani M, Hirono S, Miyazawa M, Shimizu A, Uchiyama K, Yamaue H (2011) Pylorus ring resection reduces delayed gastric emptying in patients undergoing pancreatoduodenectomy: a prospective, randomized, controlled trial of pylorus-resecting versus pylorus-preserving pancreatoduodenectomy. Ann Surg 253:495–501
Witzigmann H, Max D, Uhlmann D, Geissler F, Schwarz R, Ludwig S, Lohmann T, Caca K, Keim V, Tannapfel A, Hauss J (2003) Outcome after duodenum-preserving pancreatic head resection is improved compared with classic Whipple procedure in the treatment of chronic pancreatitis. Surgery 134:53–62
Schnelldorfer T, Adams DB (2005) The effect of malnutrition on morbidity after surgery for chronic pancreatitis. Am Surg 71:466–472
Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A (2011) Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 98:268–274
Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M (2009) ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 28:445–454
Pelzer U, Arnold D, Gövercin M, Stieler J, Doerken B, Riess H, Oettle H (2010) Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer 10:86
Brennan MF, Pisters PW, Posner M, Quesada O, Shike M (1994) A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy. Ann Surg 220:436–441
Liu Q, Liu Z, Chen H, Ma L, Liu L, Zhang J, He Y, Chen J, Qian Q (2011) Treatment with growth hormone, somatostatin, and insulin in combination with hypocaloric parenteral nutrition in gastrointestinal cancer patients after surgery. Nutrition 27:633–640
Di Carlo V, Gianotti L, Balzano G, Zerbi A, Braga M (1999) Complications of pancreatic surgery and the role of perioperative nutrition. Dig Surg 16:320–326
Baradi H, Walsh RM, Henderson JM, Vogt D, Popovich M (2004) Postoperative jejunal feeding and outcome of pancreaticoduodenectomy. J Gastrointest Surg 8:428–433
Giger U, Büchler M, Farhadi J, Berger D, Hüsler J, Schneider H, Krähenbühl S, Krähenbühl L (2007) Preoperative immunonutrition suppresses perioperative inflammatory response in patients with major abdominal surgery-a randomized controlled pilot study. Ann Surg Oncol 14:2798–2806
Gianotti L, Braga M, Gentilini O, Balzano G, Zerbi A, Di Carlo V (2000) Artificial nutrition after pancreaticoduodenectomy. Pancreas 21:344–351
Barlow R, Price P, Reid TD, Hunt S, Clark GW, Havard TJ, Puntis MC, Lewis WG (2011) Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection. Clin Nutr 30:560–566
Klek S, Sierzega M, Szybinski P, Szczepanek K, Scislo L, Walewska E, Kulig J (2011) The immunomodulating enteral nutrition in malnourished surgical patients - a prospective, randomized, double-blind clinical trial. Clin Nutr 30:282–288
Klek S, Kulig J, Sierzega M, Szczepanek K, Szybiński P, Scislo L, Walewska E, Kubisz A, Szczepanik AM (2008) Standard and immunomodulating enteral nutrition in patients after extended gastrointestinal surgery–a prospective, randomized, controlled clinical trial. Clin Nutr 27:504–512
Paccagnella A, Morassutti I, Rosti G (2011) Nutritional intervention for improving treatment tolerance in cancer patients. Curr Opin Oncol 23:322–330
Wang X, Pan L, Zhang P, Liu X, Wu G, Wang Y, Liu Y, Li N, Li J (2010) Enteral nutrition improves clinical outcome and shortens hospital stay after cancer surgery. J Invest Surg 23:309–313
Paccagnella A, Morassutti I, Rosti G (2011) Nutritional intervention for improving treatment tolerance in cancer patients. Curr Opin Oncol 23:322–330
Xue H, Sawyer MB, Wischmeyer PE, Baracos VE (2011) Nutrition modulation of gastrointestinal toxicity related to cancer chemotherapy: from preclinical findings to clinical strategy. JPEN J Parenter Enteral Nutr 35:74–90
Barber MD, Ross JA, Voss AC, Tisdale MJ, Fearon KC (1999) The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer. Br J Cancer 81:80–86
Barber MD, McMillan DC, Preston T, Ross JA, Fearon KC (2000) Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement. Clin Sci (Lond) 98:389–399
Braga M, Bissolati M, Rocchetti S, Beneduce A, Pecorelli N, Di Carlo V (2012) Oral preoperative antioxidants in pancreatic surgery: a double-blind, randomized, clinical trial. Nutrition 28:160–164
Liu C, Du Z, Lou C, Wu C, Yuan Q, Wang J, Shu G, Wang Y (2011) Enteral nutrition is superior to total parenteral nutrition for pancreatic cancer patients who underwent pancreaticoduodenectomy. Asia Pac J Clin Nutr 20:154–160
Braga M, Gianotti L, Gentilini O, Parisi V, Salis C, Di Carlo V (2001) Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition. Crit Care Med 29:242–248
van Berge Henegouwen MI, Akkermans LM, van Gulik TM, Masclee AA, Moojen TM, Obertop H, Gouma DJ (1997) Prospective, randomized trial on the effect of cyclic versus continuous enteral nutrition on postoperative gastric function after pylorus-preserving pancreatoduodenectomy. Ann Surg 226:677–685
Mercadante S (1998) Parenteral versus enteral nutrition in cancer patients: indications and practice. Support Care Cancer 6:85–93
Tanjoh K, Tomita R, Mera K, Hayashi N (2002) Metabolic modulation by concomitant administration of insulin and glucagon in pancreatectomy patients. Hepatogastroenterology 49:538–543
Domínguez-Muñoz JE (2011) Pancreatic enzyme replacement therapy for pancreatic exocrine insufficiency: when is it indicated, what is the goal and how to do it? Adv Med Sci 56:1–5
Dobrila Dintinjana R, Guina T, Krznarić Z (2008) Nutritional and pharmacologic support in patients with pancreatic cancer. Coll Antropol 32:505–508
Maskell C, Daniels P, Johnson CD (1999) Dietary intake after pancreatectomy. Br J Surg 86:323–326
Imrie CW, Connett G, Hall RI, Charnley RM (2010) Review article: enzyme supplementation in cystic fibrosis, chronic pancreatitis, pancreatic and periampullary cancer. Aliment Pharmacol Ther 32(Suppl 1):1–25
Gordon JN, Trebble TM, Ellis RD, Duncan HD, Johns T, Goggin PM (2005) Thalidomide in the treatment of cancer cachexia: a randomised placebo controlled trial. Gut 54:540–545
Yuan XY, Zhang CH, He YL, Yuan YX, Cai SR, Luo NX, Zhan WH, Cui J (2008) Is albumin administration beneficial in early stage of postoperative hypoalbuminemia following gastrointestinal surgery? A prospective randomized controlled trial. Am J Surg 196:751–755
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Karagianni, V.T., Papalois, A.E. & Triantafillidis, J.K. Nutritional Status and Nutritional Support Before and After Pancreatectomy for Pancreatic Cancer and Chronic Pancreatitis. Indian J Surg Oncol 3, 348–359 (2012). https://doi.org/10.1007/s13193-012-0189-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13193-012-0189-4