Management of nutritional issues after major pancreatic resections
Surgical resection offers the only possibility of cure for patients with peri-ampullary and pancreatic cancer.1-3 The classic Whipple?s procedure 2 and the pylorus-preserving pancreatico-duodenectomy (PPPD) 4, 5 are the two most common operative techniques used for carcinoma in the pancreatic head. For tumours located toward the body/tail of the pancreas, left sided pancreatectomy is performed. Although the operative mortality rate of these procedures is below 5% in high-volume surgical centres,1, 6, 7 the operative morbidity related to pancreatic fistula, sepsis, and delayed gastric emptying (DGE) remains high at 30% to 40%.8-10 Furthermore, as the pancreas plays a vital role in food digestion and glucose homeostasis, long-term survivors after pancreatoduodenectomy are at risk of pancreatic exocrine insufficiency and malabsorption.11 The presence of symptoms such as diarrhoea, flatulence, tenesmus, and steatorrhoea may substantially affect the quality of life of these individuals and can lead to progressive weight loss and malnutrition.12, 13 Gastrointestinal dysmotility can also be a significant clinical problem in a small proportion of patients and may lead to symptoms such as DGE, early satiety and entero-gastric reflux.14, 15 Together, these long-term complications of exocrine insufficiency and GI dysmotility after major pancreatic resection can adversely affect the oral intake and GI absorptive function of these patients and predispose them to significant malnutrition. Although the morbidity and mortality benefits of pre-operative nutritional support have been well demonstrated,16, 17 especially in malnourished patients, the impact of nutrition on long-term outcomes of patients who have had a pancreatic resection are yet to be defined. Overall, current data suggest that pancreatic resection causes a notable reduction in global quality of life.18, 19 The current chapter reviews the anatomical and physiological consequences of major pancreatic resection on gastrointestinal (GI) function, subsequent nutrition and discusses relevant issues in the management of these patients.
|ISBN||13 978 184816 364 5 101848163649|
|Authors||Nguyen, N.Q.; Merrett, N.D.; Biankin, A.V.|
|Publisher Name||When Cancer Crosses Disciplines: A Physician's Handbook|
|Published Date||2010-12-01 00:00:00|
|Published Pages||Chapter 20 pp 487-506|