Recent Advances in Pancreatic Ductal Adenocarcinoma: Strategies to Optimise the Perioperative Nutritional Status in Pancreatoduodenectomy Patients

Author:

Halle-Smith James M.12,Powell-Brett Sarah F.12ORCID,Hall Lewis A.12ORCID,Duggan Sinead N.3ORCID,Griffin Oonagh4,Phillips Mary E.5ORCID,Roberts Keith J.12

Affiliation:

1. Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2TH, UK

2. College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TH, UK

3. Department of Surgery, Trinity College Dublin, University of Dublin, Tallaght University Hospital, D24 NROA Dublin, Ireland

4. Department of Nutrition and Dietetics, St. Vincent’s University Hospital, D04 T6F4 Dublin, Ireland

5. Department of Nutrition and Dietetics, Royal Surrey County Hospital, Guildford GU2 7XX, UK

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy for which the mainstay of treatment is surgical resection, followed by adjuvant chemotherapy. Patients with PDAC are disproportionately affected by malnutrition, which increases the rate of perioperative morbidity and mortality, as well as reducing the chance of completing adjuvant chemotherapy. This review presents the current evidence for pre-, intra-, and post-operative strategies to improve the nutritional status of PDAC patients. Such preoperative strategies include accurate assessment of nutritional status, diagnosis and appropriate treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions include accurate monitoring of nutritional intake and proactive use of supplementary feeding methods, as required. There is early evidence to suggest that perioperative supplementation with immunonutrition and probiotics may be beneficial, but further study and understanding of the underlying mechanism of action are required.

Publisher

MDPI AG

Subject

Cancer Research,Oncology

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