Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature

Bartel, Michael J.; Asbun, H.; Stauffer, John; Raimondo, Massimo

doi:10.1016/j.dld.2015.06.015

Cited by 71 publications

(64 citation statements)

References 76 publications

(100 reference statements)

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“…8 Nevertheless, estimates of the prevalence of EPI based on fecal elastase-1 levels in PDAC is approximately 60–80%. 9 Despite the high prevalence of EPI in this disease group, there have been no studies to demonstrate the efficacy of PERT in PDAC, with the exception of patients who have previously undergone surgical resection. In those who undergo pancreatic surgery, the post-operative risk of EPI varies depending on the surgery type (EPI risk is higher in pancreaticoduodenectomy than distal pancreatectomy) and health of the remnant gland.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Pancreatic Cancer–Associated Weight Loss and Nutritional Interventions

et al. 2017

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Objectives Pancreatic ductal adenocarcinoma (PDAC) is often accompanied by weight loss. We sought to characterize factors associated with weight loss and observed nutritional interventions, as well as define the effect of weight loss on survival. Methods Consecutive subjects diagnosed with PDAC (n = 123) were retrospectively evaluated. Univariate analysis was used to compare subjects with and without substantial (>5%) weight loss. Multivariate logistic regression was performed to identify factors associated with weight loss, and survival analyses were performed Kaplan-Meier curves and Cox survival models. Results Substantial weight loss at diagnosis was present in 71.5% of subjects, and was independently associated with higher baseline body mass index, longer symptom duration, and increased tumor size. Recommendations for nutrition consultation and pancreatic enzyme replacement therapy occurred in 27.6% and 36.9% of subjects, respectively. Weight loss (>5%) was not associated with worse survival on multivariate analysis (hazard ratio (HR) 1.32, 95% CI, 0.76–2.30), unless a higher threshold (>10%) was used (HR 1.77, 95% CI, 1.09–2.87). Conclusions Despite the high prevalence of weight loss at PDAC diagnosis, there are low observed rates of nutritional interventions. Weight loss based on current criteria for cancer cachexia is not associated with poor survival in PDAC.

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Section: Discussionmentioning

confidence: 99%

Predictors of Pancreatic Cancer–Associated Weight Loss and Nutritional Interventions

et al. 2017

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“…However, in the context of new oncologic protocols that improve the survival of patients with pancreatic cancer, it is vital to optimize the performance status of patients with pancreatic cancer in order to make those patients eligible for new adjuvant or palliative options in the future [45]. …”

Section: Pancreatic Enzyme Replacement Therapy (Pert)mentioning

confidence: 99%

Pancreatic Exocrine Insufficiency in Pancreatic Cancer

et al. 2017

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Cancer patients experience weight loss for a variety of reasons, commencing with the tumor’s metabolism (Warburg effect) and proceeding via cachexia to loss of appetite. In pancreatic cancer, several other factors are involved, including a loss of appetite with a particular aversion to meat and the incapacity of the pancreatic gland to function normally when a tumor is present in the pancreatic head. Pancreatic exocrine insufficiency is characterized by a deficiency of the enzymes secreted from the pancreas due to the obstructive tumor, resulting in maldigestion. This, in turn, contributes to malnutrition, specifically a lack of fat-soluble vitamins, antioxidants, and other micronutrients. Patients with pancreatic cancer and pancreatic exocrine insufficiency have, overall, an extremely poor prognosis with regard to surgical outcome and overall survival. Therefore, it is crucial to be aware of the mechanisms involved in the disease, to be able to diagnose pancreatic exocrine insufficiency early on, and to treat malnutrition appropriately, for example, with pancreatic enzymes.

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“…Rates of exocrine insufficiency, lipid maldigestion and malabsorption as measured by a Lundh test, fecal elastase testing, and 13 C-trioctanoin breath testing approach 80–90% in patients with PDAC (133–136). Likely related to obstruction of the main pancreatic duct, maldigestion may be further exacerbated by biliary obstruction (134,136). Pancreatic exocrine insufficiency is also prevalent following resection, more frequently noted with pancreaticoduodectomy (>70%) than distal pancreatectomy (30–60%).…”

Section: Pancreatic Exocrine Insufficiency and Nutritional Supportmentioning

confidence: 99%

“…Pancreatic exocrine insufficiency is also prevalent following resection, more frequently noted with pancreaticoduodectomy (>70%) than distal pancreatectomy (30–60%). Indeed, pancreaticoduodenectomy and preoperative duct diameter >10 mm have been found to be predictors for maldigestion (136,137). Mechanisms for exocrine insufficiency following pancreaticoduodenectomy, beyond loss of pancreatic parenchyma, include poor mixing of chyme with pancreatic enzymes, impairment of exocrine pancreatic secretion from disruption of vagus branches, and diminished cholecystokinin and secretin stimulation after duodenal resection (136).…”

Section: Pancreatic Exocrine Insufficiency and Nutritional Supportmentioning

confidence: 99%

A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review

Fogel

Shahda

Sandrasegaran

et al. 2017

American Journal of Gastroenterology

108

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Pancreatic exocrine insufficiency in pancreatic cancer: A review of the literature

Cited by 71 publications

References 76 publications

Predictors of Pancreatic Cancer–Associated Weight Loss and Nutritional Interventions

Predictors of Pancreatic Cancer–Associated Weight Loss and Nutritional Interventions

Pancreatic Exocrine Insufficiency in Pancreatic Cancer

A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review

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