The Potential Use of a Ketogenic Diet in Pancreatobiliary Cancer Patients After Pancreatectomy

Abstract

Background/Aim: High-carbohydrate diets are generally provided to post-pancreatectomy cancer patients. Low energy density of this diet may obstruct proper energy intake and recovery. This study aimed to assess the effects of high-fat, high-energy ketogenic diet (KD) in these patients. Patients and Methods: After pancreatectomy, 9 patients were provided with general diet (GD) while 10 were served KD. Meal compliance, energy intake rate, meal satisfaction and presence of complications were monitored throughout hospital stay. Data on nutritional status, serum lipids and body composition were collected and compared between groups. Results: Meal compliance, energy intake rate and meal satisfaction score were higher in KD. There were no differences in complications, nutritional status and serum lipids. The decrease in body cell mass (BCM) was greater in GD. Conclusion: Postpancreatectomy cancer patients who consumed KD had a higher energy intake and BCM. These results suggest the potential use of KD as an adjuvant anti-cancer therapy. Pancreatic cancer accounts for 2.4% of the cancer incidence worldwide and has a particularly poor prognosis, resulting in 4.0% mortality. Gallbladder cancer accounts for 1.3% of all cancers with a mortality of 1.7% (1). Pancreatic cancer in South Korea was the eighth most common at 3% and gallbladder and other biliary cancers were the ninth most common at 2.9% in 2015 which, with regard to mortality, were ranked fifth with a rate of 7.2% and sixth with a rate of 5.6%, respectively. The five-year relative survival rate of pancreatic cancer was the lowest of all cancers at 10.8% (2). Radical resection is the only method that can completely cure pancreatobiliary cancer, as complete tumor removal can considerably reduce the risk of cancer recurrence and increase patient survival rates (3, 4). However, patients who undergo pancreatectomy are more susceptible to malnourishment and weight loss due to complications such as pancreatic fistula, delayed gastric emptying, dumping syndrome, impaired digestive enzyme secretion, dysfunctional nutrient absorption, diarrhea, and steatorrhea (5). Furthermore, delayed or reduced food intake after surgery due to difficulty in consuming food can also induce weight loss. This weight loss may subsequently impact cancer cachexia caused by malignant tumors, malnutrition, and reduced quality of life (6, 7). Multiple studies have reported that cancer patients experience at least 10% of their total weight loss within six months after surgery due to cancer cachexia and that death caused by serious weight loss accounts for 80% of deaths caused by pancreatic cancer (8). According to a 2015 Korean study, 60% of patients who undergo pancreatoduodenectomy experience at least two factors that hinder food intake and subsequent weight loss, suggesting the need to improve the standard meals provided after pancreatectomy (9). Recently, ketogenic diets (KD) have gained traction as a potential adjuvant anticancer therapy for targeting specific metabolic reactions of cancer tissu...

Addressing the controversial role of ketogenic diets in cancer treatment

“…We now have some evidence for beneficial effects of a KD on body composition in gynecological cancers [19,21], pancreatic cancer [23] and head and neck cancer patients [21]. We also have some evidence for synergistic effects between KDs and other therapies, in accordance with predictions from animal studies [2].…”

A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: An interim analysis of the KETOCOMP study

“… 15 The KD was thereby composed of roughly 25% protein which could have contributed to maintenance of FFM. Beneficial effects on body composition were also found in a small Korean pilot study conducted in pancreatic cancer patients 52 ; although only 10 out of 20 patients recruited into the KD arm finished the study (6 of them refused to eat the KD), those consuming a KD tended to lose less SMM during the weeks after pancreatectomy when compared with patients on a standard high-carbohydrate diet (p = 0.054). Since the majority of our subjects and those in the studies of Cohen et al.…”

“… 15 or Ok et al. 52 did not engage in intense exercise, a contribution of exercise-stimulated muscle protein synthesis can be ruled out as an explanation for the observed maintenance of SMM. Rather, an anti-catabolic effect of ketosis per se , combined with the anabolic effects of an adequate amino acid intake appear as the most likely explanation for the maintenance of SMM in cancer patients on a KD despite low insulin levels and weight loss.…”

Influence of pre-operative oral carbohydrate loading vs. standard fasting procedure on tumor proliferation and clinical outcome in breast cancer patients — a randomized trial

“…The present study seems to support the novel principle of manipulation of the perioperative nutrient status for adjuvant treatment purposes. Recently, the complete opposite situation with a postoperative low carbohydrate / ketogenic diet has been advocated in pancreatobiliary cancer surgery as an adjuvant anti-cancer therapy option [55].…”