Cachexia but not obesity worsens the postoperative outcome after pancreatoduodenectomy in pancreatic cancer

Pausch, Thomas; Hartwig, Werner; Hinz, Ulf; Swolana, Thomas; Bundy, B.D.; Hackert, Thilo; Grenacher, Lars; Büchler, Markus W.; Werner, Jens

doi:10.1016/j.surg.2012.05.028

Cited by 116 publications

(96 citation statements)

References 32 publications

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“…Symptoms related to pain [Porta et al 2005] and depression [Kelsen et al 1995] are components of this syndrome and are often present at the time of diagnosis, but become more severe with progression of the disease. PDA is intrinsically associated with biliary obstruction, infection, jaundice, ascites and pancreatic insufficiency, but beyond these factors PDA patients frequently experience the hypercatabolic state of cachexia and muscle wasting [Pausch et al 2012]. In addition, PDA is classically associated with hypercoagulability and development of thromboembolic disease (Trousseau's syndrome) [Khorana and Fine, 2004].…”

Section: Patient Population and Diagnosismentioning

confidence: 99%

Pancreatic cancer: why is it so hard to treat?

Oberstein

Olive

2013

Therap Adv Gastroenterol

281

201

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Abstract:No common malignancy is as rapidly and inevitably fatal as pancreatic ductal adenocarcinoma (PDA). This grim fact has driven substantial research efforts into this disease in recent decades. Unfortunately, the investment has yet to result in a meaningful increase in 5-year survival. This has prompted many pancreatic cancer researchers and advocates to redouble their efforts, but also requires one to step back and ask why the previous efforts were lacking and to consider why pancreatic cancer is so difficult to treat. The difficulties are legion. PDA is characterized by an insidious clinical syndrome, but is rarely diagnosed at a time when surgical resection is feasible. We lack markers of early detection and screening programs remain unproven even in high risk populations. The location of the tumor in the retroperitoneum, the advanced age of patients, and the systemic effects of disease limit the options for local therapy. Chemotherapy may provide a small benefit, but most efforts to improve on the current regimens consistently and stubbornly fail in advanced clinical trials. The molecular and cellular features of ductal pancreatic tumors are aggressive and underlay multiple levels of therapeutic resistance. Non-cell-autonomous features including stromal proliferation, reduced vascular density and immune suppression also contribute to therapeutic resistance. Growing awareness of these the fundamental features of PDA has begun to guide ongoing research efforts. Clinical trials are now specifically targeting these tumor properties and actively focusing on the therapeutic implications of tumor stroma. As reviewed here, reflecting on the fundamental question of why pancreatic cancer is so difficult to treat is a necessary and informative exercise that will aid our efforts to improve patient outcomes. These efforts will lead to improvements in clinical trial design, expand our focus to include the molecular and histologic implications of novel treatment paradigms, and ultimately change the lives of our patients.

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Section: Patient Population and Diagnosismentioning

confidence: 99%

Pancreatic cancer: why is it so hard to treat?

Oberstein

Olive

2013

Therap Adv Gastroenterol

281

201

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“…Despite the risks with obesity, being overweight should not be a contraindication for undergoing PD, but meticulous consultation and evaluation of these patients is critical. In a review of 408 patients who underwent PD for pan creatic adenocarcinoma, Pausch et al 12 found that patients with low BMI (,18.5 kg/m 2 ) and cachexia (unintentional weight loss, malnutrition, and systemic inflammation) had a greater 90day mortality (20% vs 0%) and a trend toward greater complication rates and inhospital mortality (6.67% vs 0%), despite a greater comorbidity in obese patients with a higher BMI. Patients with BMI between 18.5 and 30 kg/m 2 had a 90day mortality of 7.25% and an inhospital mortality of 4.83%.…”

Section: Bmimentioning

confidence: 99%

“…In pancreatic cancer, underweight patients have a poor outcome after PD than obese patients. 11,12 Severe nutritional risk predicts decreased longterm sur vival in geriatric patients undergoing PD for benign disease. Nonoperative management should be considered in geriatric patients with severe nutritional risks when malignancy is not suspected.…”

Section: Bmimentioning

confidence: 99%

Whipple procedure: patient selection and special considerations

Tan-Tam¹,

Segedi²,

Chung³

2016

OAS

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At the inception of pancreatic surgery by Dr Whipple in 1930s, the mortality and morbidity risk was more than 20%. With further understanding of disease processes and improve ments in pancreas resection techniques, the mortality risk has decreased to less than 5%. Age and chronic illnesses are no longer a contraindication to surgical treatment. Life expectancy and quality of life at a later age have improved, making older patients more likely to receive pancreatic surgery, thereby also putting emphasis on operative patient selection to minimize complica tions. This review summarizes the benign and malignant illnesses that are treated with pancreas operations, and innovations and improvements in pancreatic surgery and perioperative care, and describes the careful selection process for patients who would benefit from an operation. These indications are not reserved only to Whipple operation, but to pancreatectomies as well.

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Section: Introductionmentioning

confidence: 99%

“…Cachectic patients are observed to have lower physical function, decreased tolerance to chemotherapy and radiation treatment, and generally worse prognosis than those with stable weight. Poorer outcomes after pancreaticoduodenectomy have also been observed in patients with preoperative signs of cachexia [4].While research over the past decade has provided new insights regarding the pathogenesis of pancreatic cancer cachexia, the mechanistic pathology of this condition is still not entirely understood. In this chapter, we will provide a review of the current concepts, potential therapeutic targets, and management of this signiicant clinical condition.…”

mentioning

confidence: 99%

Pancreatic Cancer Cachexia: Current Concepts and Clinical Management

Guan¹,

Shinde²,

Hendifar³

2017

Frailty and Sarcopenia - Onset, Development and Clinical Challenges

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There has been great progress over the last decade in understanding the pathophysiology of cachexia associated with pancreatic cancer. However, there is a large need to ind better therapeutic options to successfully manage this complex and challenging condition. Patients with pancreatic cancer have some of the highest prevalence and often the most severe degrees of cachexia, which is described as a multifactorial metabolic syndrome that is associated with unintended weight loss of adipose tissue and skeletal muscle in the seting of anorexia. This chapter will review the current concepts surrounding pancreatic cancer cachexia, its clinical diagnosis, pathophysiology, and its known and proposed therapeutics. A multimodal approach utilizing nutritional support and pharmaceutical therapies is proposed to lead to the most successful management of pancreatic cancer cachexia.Keywords: pancreatic cancer, cachexia, anorexia, metabolic syndrome, catabolism IntroductionIn western countries, pancreatic cancer represents the fourth leading cause of cancer-related death [1]. Among the many complications associated with this disease, cachexia marked by progressive weight loss represents one of the most distressing features related to pancreatic cancer. Cachexia is a multidimensional wasting syndrome that is characterized by unintended loss of both adipose tissue and lean body mass (LBM) that cannot be fully reversed through conventional nutritional support. It is a complex metabolic disorder frequently described in pancreatic cancer and represents a signiicant physical and psychological burden in approximately 80% of pancreatic cancer patients during the disease progression [2]. The complications © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. associated with cachexia, which include immobility, impaired immunity, and severe respiratory muscle impairment leading to cardiopulmonary failure, result in death in up to one-third of pancreatic cancer patients [3]. Cachectic patients are observed to have lower physical function, decreased tolerance to chemotherapy and radiation treatment, and generally worse prognosis than those with stable weight. Poorer outcomes after pancreaticoduodenectomy have also been observed in patients with preoperative signs of cachexia [4].While research over the past decade has provided new insights regarding the pathogenesis of pancreatic cancer cachexia, the mechanistic pathology of this condition is still not entirely understood. In this chapter, we will provide a review of the current concepts, potential therapeutic targets, and management of this signiicant clinical condition. Classiication and progression of cancer cachexiaCachexia has been established to be a common adverse efect of cancer. An international consensus in 2011 deined cachexia as a ...

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Cachexia but not obesity worsens the postoperative outcome after pancreatoduodenectomy in pancreatic cancer

Cited by 116 publications

References 32 publications

Pancreatic cancer: why is it so hard to treat?

Pancreatic cancer: why is it so hard to treat?

Whipple procedure: patient selection and special considerations

Pancreatic Cancer Cachexia: Current Concepts and Clinical Management

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