Nutritional and immune impairments and their effects on outcomes in early pancreatic cancer patients undergoing pancreatoduodenectomy

Tumas, Jaroslav; Tumienė, Birutė; Jurkeviciene, Jolita; Jasiūnas, Eugenijus; Šileikis, Audrius

doi:10.1016/j.clnu.2020.02.029

Cited by 22 publications

(24 citation statements)

References 45 publications

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“…This indicates the significance of these parameters in PC and periampullary tumor patients. In Tumas et al's study, decreased PhA was recorded in 39% and lower fat-free mass index (FFMI) in 3.4% of early PC patients compared to the normal range [25]. FFM may be correlated with albumin level in patients with cirrhosis, but it should be recorded and assessed for each individual, like PhA.…”

Section: Bia Parametersmentioning

confidence: 96%

“…Nutritional Risk Score 2002 was found to be a good factor determining malnutrition and outcomes after surgery in PC [24]. However, in some analyses, NRS 2002 was not sufficiently sensitive to detect malnutrition or cachexia [25]. Therefore, in our analyses, we used both NRS with SGA and we assessed parameters of impaired nutritional status, mainly unintentional weight loss.…”

Section: Malnutrition Weight Loss and Bmimentioning

confidence: 99%

“…Therefore, in our analyses, we used both NRS with SGA and we assessed parameters of impaired nutritional status, mainly unintentional weight loss. In the early stage of pancreatic cancer, almost 50% of patients undergoing pancreaticoduodenectomy presented a loss of body mass [25]. In pancreatic ductal adenocarcinoma PDAC, loss of weight occurs in 88.6% of cases, with a median of 6.8 kg [14].…”

Section: Malnutrition Weight Loss and Bmimentioning

confidence: 99%

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The Relationship between Nutritional Status and Body Composition with Clinical Parameters, Tumor Stage, CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors

Jachnis

Słodkowski

2021

Current Oncology

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Recent studies have obtained inadequate data on the association between nutritional status, body composition, clinical parameters and tumor stage in patients withpancreatic and periampullary tumors. The purpose of this study was to assess the relationship between nutritional status (NS), body composition (BC) and selected clinical parameters in patients with pancreatic and periampullary cancer, as well as describe the differences between resection and non-resection groups. This is a prospective study of 76 patients with pancreatic and periampullary tumors. We evaluated NS, BMI, body mass loss (BML) and albumin, total protein, CRP, CEA, CA19-9, lipase, amylase, tumor stage, and BC using bioelectrical impedance (BIA). All subjects were divided into resection (n = 59) and non-resection (n = 17) groups. The non-resection group had a worse NS, as well as increased amylase and WBC, compared to the resection. The selected parameters of BC corresponded to BML albumin, TP, NS, age, BMI, Karnofsky, RBC, HCT and HGB. No associations were found between BC with tumor size, CRP, CA19-9, and CEA. We recorded the relationship between metastasis and NRS, as well as tumor size with SGA. The percentage of BML was positively correlated with age and CRP but negatively correlated with RBC, HGB, HCT and anthropometric measurements. We found many statistical correlations with NS and selected parameters, as well as differences between the resection and non-resection group. The detection of early prognostic factors of nutritional impairments would improve the quality of life and reduce the rate of postoperative complications.

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Section: Bia Parametersmentioning

confidence: 96%

Section: Malnutrition Weight Loss and Bmimentioning

confidence: 99%

Section: Malnutrition Weight Loss and Bmimentioning

confidence: 99%

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The Relationship between Nutritional Status and Body Composition with Clinical Parameters, Tumor Stage, CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors

Jachnis

Słodkowski

2021

Current Oncology

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“…The poor response to available treatments and the early patient's performance deterioration complicate the management of this disease: patients show an early alteration of metabolic state with a fast weight loss, causing enhanced chemotherapy (CHT) toxicities [2,3].…”

Section: Introductionmentioning

confidence: 99%

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board

et al. 2021

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Pancreatic cancer represents a very challenging disease, with an increasing incidence and an extremely poor prognosis. Peculiar features of this tumor entity are represented by pancreatic exocrine insufficiency and an early and intense nutritional imbalance, leading to the highly prevalent and multifactorial syndrome known as cancer cachexia. Recently, also the concept of sarcopenic obesity has emerged, making the concept of pancreatic cancer malnutrition even more multifaceted and complex. Overall, these nutritional derangements play a pivotal role in contributing to the dismal course of this malignancy. However, their relevance is often underrated and their assessment is rarely applied in clinical daily practice with relevant negative impact for patients’ outcome in neoadjuvant, surgical, and metastatic settings. The proper detection and management of pancreatic cancer-related malnutrition syndromes are of primary importance and deserve a specific and multidisciplinary (clinical nutrition, oncology, etc.) approach to improve survival, but also the quality of life. In this context, the introduction of a “Nutritional Oncology Board” in routine daily practice, aimed at assessing an early systematic screening of patients and at implementing nutritional support from the time of disease diagnosis onward seems to be the right path to take.

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“…Phase angle determined by the phase shift is a measure for cell integrity and may reflect body cell mass. Therefore, phase angle is a well-accepted parameter independent from equations validated in specific populations [38,39]. In our series the phase angle decreased after surgery but remained stable at six months after surgery.…”

Section: Discussionmentioning

confidence: 57%

Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer–Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period

et al. 2020

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The metabolic risk for patients undergoing abdominal cancer resection increases in the perioperative period and malnutrition may be observed. In order to prevent further weight loss, the guidelines recommend for high-risk patients the placement of a needle catheter jejunostomy (NCJ) for supplementing enteral feeding in the early and late postoperative period. Our aim was to evaluate the safety of NCJ placement and its potential benefits regarding the nutritional status in the postoperative course. We retrospectively analyzed patients undergoing surgery for upper gastrointestinal cancer, such as esophageal, gastric, and pancreato-biliary cancer, and NCJ placement during the operation. The nutritional parameters body mass index (BMI), perioperative weight loss, phase angle measured by bioelectrical impedance analysis (BIA) and the clinical outcome were assessed perioperatively and during follow-up visits 1 to 3 months and 4 to 6 months after surgery. In 102 patients a NCJ was placed between January 2006 and December 2016. Follow-up visits 1 to 3 months and 4 to 6 months after surgery were performed in 90 patients and 88 patients, respectively. No severe complications were seen after the NCJ placement. The supplementing enteral nutrition via NCJ did not improve the nutritional status of the patients postoperatively. There was a significant postoperative decline of weight and phase angle, especially in the first to third month after surgery, which could be stabilized until 4–6 months after surgery. Placement of NCJ is safe. In patients with upper gastrointestinal and pancreato-biliary cancer, supplementing enteral nutrition during the postoperative course and continued after discharge may attenuate unavoidable weight loss and a reduction of body cell mass within the first six months.

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Nutritional and immune impairments and their effects on outcomes in early pancreatic cancer patients undergoing pancreatoduodenectomy

Cited by 22 publications

References 45 publications

The Relationship between Nutritional Status and Body Composition with Clinical Parameters, Tumor Stage, CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors

The Relationship between Nutritional Status and Body Composition with Clinical Parameters, Tumor Stage, CA19-9, CEA Levels in Patients with Pancreatic and Periampullary Tumors

Clinical Implications of Malnutrition in the Management of Patients with Pancreatic Cancer: Introducing the Concept of the Nutritional Oncology Board

Needle Catheter Jejunostomy in Patients Undergoing Surgery for Upper Gastrointestinal and Pancreato-Biliary Cancer–Impact on Nutritional and Clinical Outcome in the Early and Late Postoperative Period

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