Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection

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.

The potential role of chitosan‐based nanoparticles as drug delivery systems in pancreatic cancer

“…This cancer is one of the most lethal cancers around the world in which its mortality rate is approximately 100% and in the best condition, its 5‐year survival rate was reported only 9% (in 2019) . Nutritional and metabolic derangements may increase complications of PC . The main reason why this cancer is the seventh leading cause of cancer‐related deaths worldwide is because of its poor diagnosis.…”

Nutritional support in pancreatic cancer

“…As the authors state, malnutrition and sarcopenia are factors acknowledged to be strongly associated with a limited tolerance for chemotherapy, postsurgical complications, short survival, and poor quality of life in patients with PDAC . Hence, prompt and appropriate nutritional support is mandatory in all patients with pancreatic cancer beginning with the early phases of the disease.…”

“…Unfortunately, they still are used only rarely . However, considering that the prevalence of nutritional derangements in patients with pancreatic cancer is among the highest, it may appear advisable to refer every patient with PDAC to clinical nutrition specialists for the implementation of prophylactic nutritional monitoring and/or counseling.…”

Reply to Nutritional support in pancreatic cancer

“…As mentioned in our review article, we also recommend a normal, well‐balanced diet consumed in small, frequent meals that are rich in protein; avoids high‐fat foods or refined/simple carbohydrates; and is accompanied by pancreatic enzyme replacement therapy to significantly improve malabsorption, abdominal pain, and quality of life . Enteral nutrition (EN) is superior for improving the nutritional status of patients with PDAC compared with parenteral nutrition and is the preferred method whenever possible . EN demonstrates enhanced substrate use; prevents gastrointestinal mucosal atrophy; applies a trophic effect to prevent bacterial translocation into the bloodstream; and maintains gastrointestinal tract integrity, motility, and immunocompetence .…”

“…Enteral nutrition (EN) is superior for improving the nutritional status of patients with PDAC compared with parenteral nutrition and is the preferred method whenever possible . EN demonstrates enhanced substrate use; prevents gastrointestinal mucosal atrophy; applies a trophic effect to prevent bacterial translocation into the bloodstream; and maintains gastrointestinal tract integrity, motility, and immunocompetence . Furthermore, in the perioperative pancreaticoduodenectomy setting, EN is superior for nutritional support, blood glucose levels, hepatobiliary and kidney function, and overall mortality .…”