title: 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.
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Taylor.Gilliland@bcm.edu.
authors.forename: Taylor M
authors.initials: TM
authors.lastname: Gilliland
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Nicole.Villafane@bcm.edu.
authors.forename: Nicole
authors.initials: N
authors.lastname: Villafane-Ferriol
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Kevin.Shah@bcm.edu.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Shah
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Rohan.Shah@bcm.edu.
authors.forename: Rohan M
authors.initials: RM
authors.lastname: Shah
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Hop.TranCao@bcm.edu.
authors.forename: Hop S
authors.initials: HS
authors.lastname: Tran Cao
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Nader.Massarweh@bcm.edu.
authors.forename: Nader N
authors.initials: NN
authors.lastname: Massarweh
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. ejs@bcm.edu.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Silberfein
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Eugene.Choi@bcm.edu.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Choi
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Cary.Hsu@bcm.edu.
authors.forename: Cary
authors.initials: C
authors.lastname: Hsu
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Amy.McElhany@bcm.edu.
authors.forename: Amy L
authors.initials: AL
authors.lastname: McElhany
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. Omar.Barakat@bcm.edu.
authors.forename: Omar
authors.initials: O
authors.lastname: Barakat
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. wfisher@bcm.edu.
authors.forename: William
authors.initials: W
authors.lastname: Fisher
authors.affiliation: The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA. George.vanburen@bcm.edu.
authors.forename: George
authors.initials: G
authors.lastname: Van Buren
mesh_terms: D015415:Biomarkers / Q000097:blood / Q000652:urine; D016208:Databases, Factual; D006801:Humans; D044342:Malnutrition / Q000150:complications; D008659:Metabolic Diseases / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D065228:Non-Randomized Controlled Trials as Topic; D009752:Nutritional Status; D018529:Nutritional Support; D010179:Pancreas / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
chemical_list: D015415:Biomarkers
keywords: diabetes mellitus; distal pancreatectomy; enteral nutrition; malnutrition; nutrition; pancreas adenocarcinoma; pancreas cancer; pancreatic exocrine insufficiency; pancreaticoduodenectomy; pancreatogenic diabetes