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Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS).

Published on Nov 1, 2018in Surgery3.476
· DOI :10.1016/j.surg.2018.05.040
Luca Gianotti3
Estimated H-index: 3
(University of Milan),
Marc G. Besselink50
Estimated H-index: 50
(UvA: University of Amsterdam)
+ 33 AuthorsClaudio Bassi80
Estimated H-index: 80
(University of Verona)
Sources
Abstract
Background The optimal nutritional therapy in the field of pancreatic surgery is still debated. Methods An international panel of recognized pancreatic surgeons and pancreatologists decided that the topic of nutritional support was of importance in pancreatic surgery. Thus, they reviewed the best contemporary literature and worked to develop a position paper to provide evidence supporting the integration of appropriate nutritional support into the overall management of patients undergoing pancreatic resection. Strength of recommendation and quality of evidence were based on the approach of the grading of recommendations assessment, development and evaluation Working Group. Results The measurement of nutritional status should be part of routine preoperative assessment because malnutrition is a recognized risk factor for surgery-related complications. In addition to patient's weight loss and body mass index, measurement of sarcopenia and sarcopenic obesity should be considered in the preoperative evaluation because they are strong predictors of poor short-term and long-term outcomes. The available data do not show any definitive nutritional advantages for one specific type of gastrointestinal reconstruction technique after pancreatoduodenectomy over the others. Postoperative early resumption of oral intake is safe and should be encouraged within enhanced recovery protocols, but in the case of severe postoperative complications or poor tolerance of oral food after the operation, supplementary artificial nutrition should be started at once. At present, there is not enough evidence to show the benefit of avoiding oral intake in clinically stable patients who are complicated by a clinically irrelevant postoperative pancreatic fistula (a so-called biochemical leak), while special caution should be given to feeding patients with clinically relevant postoperative pancreatic fistula orally. When an artificial nutritional support is needed, enteral nutrition is preferred whenever possible over parenteral nutrition. After the operation, regardless of the type of pancreatic resection or technique of reconstruction, patients should be monitored carefully to assess for the presence of endocrine and exocrine pancreatic insufficiency. Although fecal elastase-1 is the most readily available clinical test for detection of pancreatic exocrine insufficiency, its sensitivity and specificity are low. Pancreatic enzyme replacement therapy should be initiated routinely after pancreatoduodenectomy and in patients with locally advanced disease and continued for at least 6 months after surgery, because untreated pancreatic exocrine insufficiency may result in severe nutritional derangement. Conclusion The importance of this position paper is the consensus reached on the topic. Concentrating on nutritional support and therapy is of utmost value in pancreatic surgery for both short- and long-term outcomes.
  • References (211)
  • Citations (18)
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References211
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#1Marta Sandini (University of Milano-Bicocca)H-Index: 4
#2Manuel Patino (Harvard University)H-Index: 9
Last. Carlos Fernandez-del Castillo (Harvard University)H-Index: 82
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Importance Sarcopenia and sarcopenic obesity have been associated with poor outcomes in unresectable pancreatic cancer (PC). Neoadjuvant treatment (NT) is used increasingly to improve resectability; however, its effects on fat and muscle body composition have not been characterized. Objectives To evaluate whether NT affects muscle mass and adipose tissue in patients with borderline resectable PC (BRPC) and locally advanced PC (LAPC) and determine whether there were potential differences between ...
11 CitationsSource
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#2Taiichi Wakiya (Hirosaki University)H-Index: 7
Last. Kenichi Hakamada (Hirosaki University)H-Index: 20
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#1David P. J. van Dijk (UM: Maastricht University)H-Index: 4
#2Frans C. H. Bakers (Maastricht University Medical Centre)H-Index: 12
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#1Kenta SuiH-Index: 3
#2Takehiro OkabayshiH-Index: 1
Last. Yasuhiro ShimadaH-Index: 27
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Purposes Sarcopenia is known to be associated with a worse prognosis following abdominal operations; however, the relationship between sarcopenia and the outcomes of pancreaticoduodenectomy remains unclear.
4 CitationsSource
#1Jordan M. Cloyd (University of Texas MD Anderson Cancer Center)H-Index: 9
#2Graciela M. Nogueras-Gonzalez (University of Texas MD Anderson Cancer Center)H-Index: 19
Last. Matthew Harold Katz (University of Texas MD Anderson Cancer Center)H-Index: 41
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#1G. Carrara (UniSR: Vita-Salute San Raffaele University)H-Index: 3
#2Nicolò Pecorelli (UniSR: Vita-Salute San Raffaele University)H-Index: 14
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#1Marta SandiniH-Index: 9
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#1Jukes P. NammH-Index: 8
#2Kiran H. ThakrarH-Index: 7
Last. Kevin K. RogginH-Index: 29
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Background: Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy. Methods: Preoperative computed tomography (CT) scans of patients unde...
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#1Neil Bibby (Manchester Royal Infirmary)
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#1Irene Deftereos (University of Melbourne)
#2Nicole Kiss (Deakin University)
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Pancreaticoduodenectomy (PD) is the commonest procedure performed for pancreatic cancer. Pancreatic exocrine insufficiency (PEI) may be caused or exacerbated by surgery and remains underdiagnosed and undertreated. The aim of this review was to ascertain the incidence of PEI, its consequences and management in the setting of PD for indications other than chronic pancreatitis. A literature search of databases (MEDLINE, EMBASE, Cochrane and Scopus) was carried out with the MeSH terms "pancreatic ex...
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#1A. P. Koshel (Siberian State Medical University)H-Index: 1
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