Nutrition Implications for Long‐Term Survivors of Pancreatic Cancer Surgery

Abstract

With slowly increasing survival rates in pancreatic cancer and international consensus guidelines recommending surgical resection of premalignant lesions, survival post-pancreatic resection is increasing. With longer survival time, the significant comorbidities of such major surgery have far-reaching effects on the nutrition status of the survivor of pancreatic cancer. This review describes the many nutrition-related side effects of pancreatic surgery, including the development of pancreatic enzyme insufficiency, micronutrient deficiencies, diabetes, fatty liver, and metabolic bone disease. Beyond causing additional medical problems, each of these can have significant effects on quality of life and functional status. The potential mechanisms, diagnosis criteria, and potential treatments of these conditions are described. Overall, little literature exists to fully describe the effects of these comorbidities, and even less is able to guide effective treatments for this population. Clinicians caring for these patients should begin incorporating goals for promotion of long-term health and reduction of these known and reported comorbidities in patients who have undergone pancreatic surgery. Treatment plans in this population remain understudied, and clinicians may need to consider recommendations for similar disease states when developing interventions for these patients.

Micronutritional status after pylorus preserving duodenopancreatectomy: analysis of data from a randomized controlled trial

“…Therefore, it has been postulated that patients after pancreaticoduodenectomy (PD) might show deficiencies in several micronutrients including fat-soluble vitamins D and E, selenium and iron, independent of dietary intake or of pancreatic exocrine function, and therefore clinical recommendations for micronutrient evaluation have been issued 9 , 10 . But long-term data concerning the time course of micronutrient levels after cancer-related pancreatic head resection are missing 11 .…”

Mechanisms of nonalcoholic fatty liver disease and implications for surgery

“…A reduced number of patients develop NAFLD in the treatment group vs historical controls [54]. Still, studies have not shown whether stopping enzyme supplementation leads to a refractory appearance of fatty liver [50]. It should be noted that not all patients receiving pancreatic enzyme supplementation were protected from NAFLD, and spontaneous NAFLD regression was observed in patients without treatment.…”

“…The underlying pancreatic disease, the surgical procedure performed, and the extent of tissue loss are prognostic factors for the development of EPI. EPI is reported in 50-100% of oncological patients' post-PD as opposed to 0-42% in distal pancreatectomy [50]. Pancreatic head cancer is a constant risk factor for de novo post-PD NAFLD, and it is conceivable that it is due to a small and atrophic remnant pancreas following surgery, which increases the risk of EPI exponentially [45].…”

“…Instead, inadequate digestion, absorption, and pancreatic exocrine function dominate the pathophysiology of NAFLD after pancreatic surgery [43,44]. Theories include malabsorption of amino acids or fat-soluble nutrients, which promote triglyceride accumulation in the liver and an increased conversion of carbohydrates into fat [50]. Steatogenic mechanisms in the post-PD liver include increased FFA uptake and lipogenesis, upregulation of PPARγ, and impairment of VLDL export from the liver [52].…”

Pancreatic resection in patients with synchronous extra‐pancreatic malignancy: outcomes and complications

“…The reported rate of major post‐operative complications and 30‐day mortality is as high as 40% and 9%, respectively . In addition, many patients suffer long‐term complications associated with pancreatectomies, including diabetes, pancreatic exocrine insufficiency, malnutrition and gastrointestinal motility disorders . It is therefore essential that pancreatic resections are offered to patients with satisfactory pre‐morbid status who receive appropriate counselling and support prior to and following their pancreatectomy.…”