Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer
Abstract
:Simple Summary
Abstract
1. Introduction
2. Causes and Pathomechanism of Malnutrition in Patients with PC
3. Methods of the Literature Research
4. Assessment of Nutritional Status
5. Nutritional Treatment
5.1. Nutritional Counseling
5.2. Oral Nutritional Supplements
5.3. Pancreatic Enzyme Replacement Therapy (PERT)
5.4. Enteral (EN) and Parenteral (PN) Nutrition
5.5. Medical Nutrition Depending on the Stage of Pancreatic Cancer
5.6. Preoperative Nutritional Support
- (1)
- Weight loss (WL) > 15% in 6 months;
- (2)
- BMI < 18.5 kg/m2;
- (3)
- Subjective global assessment (SGA), grade C or assessment of risk related to the nutritional status;
- (4)
- Serum albumin < 30 g/L.
6. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
References
- Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global Cancer Statistics 2020: Globocan Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021, 71, 209–249. [Google Scholar] [CrossRef]
- Huang, J.; Lok, V.; Ngai, C.H.; Zhang, L.; Yuan, J.; Lao, X.Q.; Ng, K.; Chong, C.; Zheng, Z.J.; Wong, M.C. Worldwide burden of Risk Factors for and trends in Pancreation Cancer. Gastroenterology 2021, 160, 744–754. [Google Scholar] [CrossRef] [PubMed]
- McGuigan, A.; Kelly, P.; Turkington, R.C.; Jones, C.; Coleman, H.G.; McCain, R.S. Pancreatic cancer: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J. Gastroenterol. 2018, 24, 4846–4861. [Google Scholar] [CrossRef] [PubMed]
- Gilliland, T.M.; Villafane-Ferriol, N.; Shah, K.P.; Shah, R.M.; Tran Cao, H.S.; Massarweh, N.N.; Silberfein, E.J.; Choi, E.A.; Hsu, C.; McElhany, A.L.; et al. Nutritional and metabolic derangements in pancreatic cancer and pancreatic resection. Nutrients 2017, 9, 243. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Santos, I.; Mendes, L.; Mansinho, H.; Santos, C.A. Nutritional status and functional status of the pancreatic cancer patients and the impact of adjacent symptoms. Clin. Nutr. 2021, 40, 5486–5493. [Google Scholar] [CrossRef] [PubMed]
- Ducreux, M.; Cuhna, A.S.; Caramella, C.; Hollebecque, A.; Burtin, P.; Goéré, D.; Seufferlein, T.; Haustermans, K.; Van Laethem, J.L.; Conroy, T.; et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2015, 26 (Suppl. S5), 56–68. [Google Scholar] [CrossRef]
- Ryan, A.M.; Power, D.G.; Daly, L.; Cushen, S.J.; Ní Bhuachalla, E.; Prado, C.M. Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later. Proc. Nutr. Soc. 2016, 75, 199–211. [Google Scholar] [CrossRef]
- Martin, L.; Senesse, P.; Gioulbasanis, I.; Antoun, S.; Bozzetti, F.; Deans, C.; Strasser, F.; Thoresen, L.; Jagoe, R.T.; Chasen, M.; et al. Diagnostic criteria for the classification of cancer-associated weight loss. J. Clin. Oncol. 2015, 33, 90–99. [Google Scholar] [CrossRef]
- Arends, J.; Baracos, V.; Bertz, H.; Bozzetti, F.; Calder, P.C.; Deutz, N.E.; Erickson, N.; Laviano, A.; Lisanti, M.P.; Lobo, D.N.; et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin. Nutr. 2017, 36, 1187–1196. [Google Scholar] [CrossRef] [Green Version]
- Bundred, J.; Kamarajah, S.K.; Roberts, K.J. Body composition assessment and sarcopenia in patients with pancreatic cancer: A systematic review and meta-analysis. HPB 2019, 21, 1603–1612. [Google Scholar] [CrossRef]
- Zhang, Y.X.; Yang, Y.F.; Han, P.; Ye, P.C.; Kong, H. Protein-energy malnutrition worsens hospitalization outcomes of patients with pancreatic cancer undergoing open pancreaticoduodenectomy. Updates Surg. 2022, 74, 1627–1636. [Google Scholar] [CrossRef] [PubMed]
- Poulia, K.A.; Antoniadou, D.; Sarantis, P.; Karamouzis, M.V. Pancreatic Cancer Prognosis, Malnutrition Risk, and Quality of Life: A Cross-Sectional Study. Nutrients 2022, 14, 442. [Google Scholar] [CrossRef] [PubMed]
- Fearon, K.; Strasser, F.; Anker, S.D.; Bosaeus, I.; Bruera, E.; Fainsinger, R.L.; Jatoi, A.; Loprinzi, C.; MacDonald, N.; Mantovani, G.; et al. Definition and classification of cancer cachexia: An international consensus. Lancet Oncol. 2011, 12, 489–495. [Google Scholar] [CrossRef] [PubMed]
- Latenstein, A.E.; Dijksterhuis, W.P.; Mackay, T.M.; Beijer, S.; van Eijck, C.H.; de Hingh, I.H.; Molenaar, I.Q.; van Oijen, M.G.; van Santvoort, H.C.; de van der Schueren, M.A.; et al. Cachexia, dietetic consultation, and survival in patients with pancreatic and periampullary cancer: A multicenter cohort study. Cancer Med. 2020, 9, 9385–9395. [Google Scholar] [CrossRef]
- Emanuel, A.; Krampitz, J.; Rosenberger, F.; Kind, S.; Rötzer, I. Nutritional Interventions in Pancreatic Cancer: A Systematic Review. Cancers 2022, 14, 2212. [Google Scholar] [CrossRef]
- Rovesti, G.; Valoriani, F.; Rimini, M.; Bardasi, C.; Ballarin, R.; Di Benedetto, F.; Menozzi, R.; Dominici, M.; Spallanzani, A. Clinical implications of malnutrition in the management of patients with pancreatic cancer: Introducing the concept of the nutritional oncology board. Nutrients 2021, 13, 3522. [Google Scholar] [CrossRef]
- Skipper, A.; Ferguson, M.; Thompson, K.; Castellanos, V.H.; Porcari, J. Nutrition screening tools: An analysis of the evidence. J. Parenter. Enter. Nutr. 2012, 36, 292–298. [Google Scholar] [CrossRef]
- Caccialanza, R.; Cereda, E.; Pinto, C.; Cotogni, P.; Farina, G.; Gavazzi, C.; Gandini, C.; Nardi, M.; Zagonel, V.; Pedrazzoli, P. Awareness and consideration of malnutrition among oncologists: Insights from an exploratory survey. Nutrition 2016, 32, 1028–1032. [Google Scholar] [CrossRef]
- Hébuterne, X.; Lemarié, E.; Michallet, M.; De Montreuil, C.B.; Schneider, S.M.; Goldwasser, F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. J. Parenter. Enter. Nutr. 2014, 38, 196–204. [Google Scholar] [CrossRef]
- Cederholm, T.; Jensen, G.L.; Correia, M.I.; Gonzalez, M.C.; Fukushima, R.; Higashiguchi, T.; Baptista, G.; Barazzoni, R.; Blaauw, R.; Coats, A.J.; et al. GLIM criteria for the diagnosis of malnutrition—A consensus report from the global clinical nutrition community. Clin. Nutr. 2019, 38, 1–9. [Google Scholar] [CrossRef] [Green Version]
- Sanchez-Rodriguez, D.; Locquet, M.; Bruyère, O.; Lengelé, L.; Cavalier, E.; Reginster, J.Y.; Beaudart, C. Prediction of 5-year mortality risk by malnutrition according to the GLIM format using seven pragmatic approaches to define the criterion of loss of muscle mass. Clin. Nutr. 2021, 40, 2188–2199. [Google Scholar] [CrossRef]
- Kakavas, S.; Karayiannis, D.; Bouloubasi, Z.; Poulia, K.A.; Kompogiorgas, S.; Konstantinou, D.; Vougas, V. Global leadership initiative on malnutrition criteria predict pulmonary complications and 90-day mortality after major abdominal surgery in cancer patients. Nutrients 2020, 12, 3726. [Google Scholar] [CrossRef]
- Zhang, X.; Tang, M.; Zhang, Q.; Zhang, K.P.; Guo, Z.Q.; Xu, H.X.; Yuan, K.T.; Yu, M.; Braga, M.; Cederholm, T.; et al. The GLIM criteria as an effective tool for nutrition assessment and survival prediction in older adult cancer patients. Clin. Nutr. 2021, 40, 1224–1232. [Google Scholar] [CrossRef] [PubMed]
- Takimoto, M.; Yasui-Yamada, S.; Nasu, N.; Kagiya, N.; Aotani, N.; Kurokawa, Y.; Tani-Suzuki, Y.; Kashihara, H.; Saito, Y.; Nishi, M.; et al. Development and Validation of Cutoff Value for Reduced Muscle Mass for GLIM Criteria in Patients with Gastrointestinal and Hepatobiliary–Pancreatic Cancers. Nutrients 2022, 14, 943. [Google Scholar] [CrossRef] [PubMed]
- Almeida, A.I.; Correia, M.; Camilo, M.; Ravasco PAlmeida, A.I.; Correia, M.; Camilo, M.; Ravasco, P. Nutritional risk screNutritional risk screening in surgery: Valid, feasible, easy! Clin. Nutr. 2012, 31, 206–211. [Google Scholar] [CrossRef] [PubMed]
- Carrato, A.; Cerezo, L.; Feliu, J.; Macarulla, T.; Martin-Perez, E.; Vera, R.; Álvarez, J.; Botella-Carretero, J.I. Clinical nutrition as part of the treatment pathway of pancreatic cancer patients: An expert consensus. Clin. Transl. Oncol. 2022, 24, 112–126. [Google Scholar] [CrossRef]
- Pecorelli, N.; Carrara, G.; De Cobelli, F.; Cristel, G.; Damascelli, A.; Balzano, G.; Beretta, L.; Braga, M. Effect of sarcopenia and visceral obesity on mortality and pancreatic fistula following pancreatic cancer surgery. Br. J. Surg. 2016, 103, 434–442. [Google Scholar] [CrossRef]
- Carrara, G.; Pecorelli, N.; De Cobelli, F.; Cristel, G.; Damascelli, A.; Beretta, L.; Braga, M. Preoperative sarcopenia determinants in pancreatic cancer patients. Clin. Nutr. 2017, 36, 1649–1653. [Google Scholar] [CrossRef]
- Gianotti, L.; Besselink, M.G.; Sandini, M.; Hackert, T.; Conlon, K.; Gerritsen, A.; Griffin, O.; Fingerhut, A.; Probst, P.; Hilal, M.A.; et al. Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2018, 164, 1035–1048. [Google Scholar] [CrossRef]
- Akahori, T.; Sho, M.; Kinoshita, S.; Nagai, M.; Nishiwada, S.; Tanaka, T.; Tamamoto, T.; Ohbayashi, C.; Hasegawa, M.; Kichikawa, K.; et al. Prognostic Significance of Muscle Attenuation in Pancreatic Cancer Patients Treated with Neoadjuvant Chemoradiotherapy. World J. Surg. 2015, 39, 2975–2982. [Google Scholar] [CrossRef]
- Romieu, I.; Trenga, C. Diet and Obstructive Lung Diseases. Epidemiol. Rev. 2001, 23, 268–287. [Google Scholar] [CrossRef] [Green Version]
- Perrini, S.; Leonardini, A.; Laviola, L.; Giorgino, F. Biological specificity of visceral adipose tissue and therapeutic intervention. Arch. Physiol. Biochem. 2008, 114, 277–286. [Google Scholar] [CrossRef] [PubMed]
- Amini, N.; Spolverato, G.; Gupta, R.; Margonis, G.A.; Kim, Y.; Wagner, D.; Rezaee, N.; Weiss, M.J.; Wolfgang, C.L.; Makary, M.M.; et al. Impact Total Psoas Volume on Short- and Long-Term Outcomes in Patients Undergoing Curative Resection for Pancreatic Adenocarcinoma: A New Tool to Assess Sarcopenia. J. Gastrointest. Surg. 2015, 19, 1593–1602. [Google Scholar] [CrossRef]
- Cooper, C.; Burden, S.T.; Molassiotis, A. An explorative study of the views and experiences of food and weight loss in patients with operable pancreatic cancer perioperatively and following surgical intervention. Support. Care Cancer 2015, 23, 1025–1033. [Google Scholar] [CrossRef]
- Bachmann, J.; Heiligensetzer, M.; Krakowski-Roosen, H.; Büchler, M.W.; Friess, H.; Martignoni, M.E. Cachexia worsens prognosis in patients with resectable pancreatic cancer. J. Gastrointest. Surg. 2008, 12, 1193–1201. [Google Scholar] [CrossRef]
- Sandini, M.; Pinotti, E.; Persico, I.; Picone, D.; Bellelli, G.; Gianotti, L. Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery. BJS Open 2017, 1, 128–137. [Google Scholar] [CrossRef] [PubMed]
- Karagianni, V.T.; Papalois, A.E.; Triantafillidis, J.K. Nutritional Status and Nutritional Support before and after Pancreatectomy for Pancreatic Cancer and Chronic Pancreatitis. Indian J. Surg. Oncol. 2012, 3, 348–359. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Martin, L.; Birdsell, L.; MacDonald, N.; Reiman, T.; Clandinin, M.T.; McCargar, L.J.; Murphy, R.; Ghosh, S.; Sawyer, M.B.; Baracos, V.E. Cancer cachexia in the age of obesity: Skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J. Clin. Oncol. 2013, 31, 1539–1547. [Google Scholar] [CrossRef] [PubMed]
- Ma, X.; Zou, W.; Sun, Y. Prognostic Value of Pretreatment Controlling Nutritional Status Score for Patients with Pancreatic Cancer: A Meta-Analysis. Front Oncol. 2022, 11, 770894. [Google Scholar] [CrossRef]
- Caraceni, P.; Tufoni, M.; Bonavita, M.E. Clinical use of albumin. Blood Transfus. 2013, 11 (Suppl. 4), S18–S25. [Google Scholar]
- Gupta, D.; Lis, C.G. Pretreatment serum albumin as a predictor of cancer survival: A systematic review of the epidemiological literature. Nutr. J. 2010, 9, 69. Available online: http://www.nutritionj.com/content/9/1/69 (accessed on 1 January 2023). [CrossRef] [Green Version]
- Väyrynen, J.P.; Tuomisto, A.; Klintrup, K.; Mäkelä, J.; Karttunen, T.J.; Mäkinen, M.J. Detailed analysis of inflammatory cell infiltration in colorectal cancer. Br. J. Cancer 2013, 109, 1839–1847. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chimento, A.; Casaburi, I.; Avena, P.; Trotta, F.; De Luca, A.; Rago, V.; Pezzi, V.; Sirianni, R. Cholesterol and its metabolites in tumor growth: Therapeutic potential of statins in cancer treatment. Front. Endocrinol. 2019, 10, 807. [Google Scholar] [CrossRef] [Green Version]
- Kato, Y.; Yamada, S.; Suenaga, M.; Takami, H.; Niwa, Y.; Hayashi, M.; Iwata, N.; Kanda, M.; Tanaka, C.; Nakayama, G.; et al. Impact of the Controlling Nutritional Status Score on the Prognosis after Curative Resection of Pancreatic Ductal Adenocarcinoma. Pancreas 2018, 47, 823–829. [Google Scholar] [CrossRef]
- Menozzi, R.; Valoriani, F.; Ballarin, R.; Alemanno, L.; Vinciguerra, M.; Barbieri, R.; Cuoghi Costantini, R.; D’Amico, R.; Torricelli, P.; Pecchi, A. Impact of Nutritional Status on Postoperative Outcomes in Cancer Patients following Elective Pancreatic Surgery. Nutrients 2023, 15, 1958. [Google Scholar] [CrossRef]
- Vashi, P.; Popiel, B.; Lammersfeld, C.; Gupta, D. Outcomes of Systematic Nutritional Assessment and Medical Nutrition Therapy in Pancreatic Cancer. Pancreas 2015, 44, 750–755. [Google Scholar] [CrossRef]
- Zhou, S.; Yu, Z.; Shi, X.; Zhao, H.; Dai, M.; Chen, W. The Relationship between Phase Angle, Nutrition Status, and Complications in Patients with Pancreatic Head Cancer. Int. J. Environ. Res. Public Health 2022, 19, 6426. [Google Scholar] [CrossRef]
- Mao, Y.S.; Hao, S.J.; Zou, C.F.; Xie, Z.B.; Fu, D.L. Controlling Nutritional Status score is superior to Prognostic Nutritional Index score in predicting survival and complications in pancreatic ductal adenocarcinoma: A Chinese propensity score matching study. Br. J. Nutr. 2020, 124, 1190–1197. [Google Scholar] [CrossRef] [PubMed]
- Phillips, M.E.; Robertson, M.D.; Hart, K.; Kumar, R.; Pencavel, T. Long-term changes in nutritional status and body composition in patients with malignant pancreatic disease—A systematic review. Clin. Nutr. ESPEN 2021, 44, 85–95. [Google Scholar] [CrossRef]
- Jabłonska, B.; Pawlicki, K.; Mrowiec, S. Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis. Cancer 2021, 13, 5041. [Google Scholar] [CrossRef] [PubMed]
- Cañamares-Orbís, P.; García-Rayado, G.; Alfaro-Almajano, E. Nutritional Support in Pancreatic Diseases. Nutrients 2022, 14, 4570. [Google Scholar] [CrossRef]
- Martin, D.; Joliat, G.R.; Halkic, N.; Demartines, N.; Schäfer, M. Perioperative nutritional management of patients undergoing pancreatoduodenectomy: An international survey among surgeons. HPB 2020, 22, 75–82. [Google Scholar] [CrossRef] [PubMed]
- Lassen, K.; Coolsen, M.M.; Slim, K.; Carli, F.; de Aguilar-Nascimento, J.E.; Schäfer, M.; Parks, R.W.; Fearon, K.C.; Lobo, D.N.; Demartines, N.; et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced recovery after surgery (ERAS®) society recommendations. World J. Surg. 2013, 37, 240–258. [Google Scholar] [CrossRef] [Green Version]
- Hasegawa, Y.; Ijichi, H.; Saito, K.; Ishigaki, K.; Takami, M.; Sekine, R.; Usami, S.; Nakai, Y.; Koike, K.; Kubota, N. Protein intake after the initiation of chemotherapy is an independent prognostic factor for overall survival in patients with unresectable pancreatic cancer: A prospective cohort study. Clin. Nutr. 2021, 40, 4792–4798. [Google Scholar] [CrossRef]
- Cintoni, M.; Grassi, F.; Palombaro, M.; Rinninella, E.; Pulcini, G.; Di Donato, A.; Salvatore, L.; Quero, G.; Tortora, G.; Alfieri, S.; et al. Nutritional Interventions during Chemotherapy for Pancreatic Cancer: A Systematic Review of Prospective Studies. Nutrients 2023, 15, 727. [Google Scholar] [CrossRef]
- Tanaka, Y.; Shimokawa, T.; Harada, K.; Yoshida, K. Effectiveness of elemental diets to prevent oral mucositis associated with cancer therapy: A meta-analysis. Clin. Nutr. ESPEN 2022, 49, 172–180. [Google Scholar] [CrossRef]
- Grupińska, J.; Budzyń, M.; Maćkowiak, K.; Brzeziński, J.J.; Kycler, W.; Leporowska, E.; Gryszczyńska, B.; Kasprzak, M.P.; Iskra, M.; Formanowicz, D. Beneficial effects of oral nutritional supplements on body composition and biochemical parameters in women with breast cancer undergoing postoperative chemotherapy: A propensity score matching analysis. Nutrients 2021, 13, 3549. [Google Scholar] [CrossRef] [PubMed]
- Petzel, M.Q.B.; Hoffman, L. Nutrition Implications for Long-Term Survivors of Pancreatic Cancer Surgery. Nutr. Clin. Pract. 2017, 32, 588–598. [Google Scholar] [CrossRef] [PubMed]
- Sabater, L.; Ausania, F.; Bakker, O.J.; Boadas, J.; Domínguez-Muñoz, J.E.; Falconi, M.; Fernández-Cruz, L.; Frulloni, L.; González-Sánchez, V.; Lariño-Noia, J.; et al. Evidence-based guidelines for the management of exocrine pancreatic insufficiency after pancreatic surgery. Ann. Surg. 2016, 264, 949–958. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sarner, M. Treatment of Pancreatic Exocrine Deficiency. World J. Surg. 2003, 27, 1192–1195. [Google Scholar] [CrossRef]
- Bruno, M.J.; Haverkort, E.B.; Tijssen, G.P.; Tytgat, G.N.J.; Van Leeuwen, D.J. Placebo controlled trial of enteric coated pancreatin microsphere treatment in patients with unresectable cancer of the pancreatic head region. Gut 1998, 42, 92–96. [Google Scholar] [CrossRef] [Green Version]
- Roberts, K.J.; Bannister, C.A.; Schrem, H. Enzyme replacement improves survival among patients with pancreatic cancer: Results of a population based study. Pancreatology 2019, 19, 114–121. [Google Scholar] [CrossRef]
- Kanthasamy, K.A.; Akshintala, V.S.; Singh, V.K. Nutritional Management of Acute Pancreatitis. Acute Pancreat. Nutr. Enter. Nutr. 2021, 50, 21205. [Google Scholar] [CrossRef]
- Madariaga, A.; Lau, J.; Ghoshal, A.; Dzierżanowski, T.; Larkin, P.; Sobocki, J.; Dickman, A.; Furness, K.; Fazelzad, R.; Crawford, G.B.; et al. MASCC multidisciplinary evidence-based recommendations for the management of malignant bowel obstruction in advanced cancer. Support. Care Cancer 2022, 30, 4711–4728. [Google Scholar] [CrossRef]
- Chawla, A.; Ferrone, C.R. Neoadjuvant therapy for resectable pancreatic cancer: An evolving paradigm shift. Front. Oncol. 2019, 9, 10–13. [Google Scholar] [CrossRef] [Green Version]
- Ruarus, A.; Vroomen, L.; Puijk, R.; Scheffer, H.; Meijerink, M. Locally advanced pancreatic cancer: A review of local ablative therapies. Cancers 2018, 10, 16. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bilimoria, K.Y.; Bentrem, D.J.; Ko, C.Y.; Ritchey, J.; Stewart, A.K.; Winchester, D.P.; Talamonti, M.S. Validation of the 6th edition AJCC pancreatic cancer staging system: Report from the National Cancer Database. Cancer 2007, 110, 738–744. [Google Scholar] [CrossRef]
- Duconseil, P.; Garnier, J.; Weets, V.; Ewald, J.; Marchese, U.; Gilabert, M.; Moureau-Zabotto, L.; Poizat, F.; Giovannini, M.; Delpero, J.R.; et al. Effect of clinical status on survival in patients with borderline or locally advanced pancreatic adenocarcinoma. World J. Surg. Oncol. 2019, 17, 95. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Fujii, T.; Nakao, A.; Murotani, K.; Okamura, Y.; Ishigure, K.; Hatsuno, T.; Sakai, M.; Yamada, S.; Kanda, M.; Sugimoto, H.; et al. Influence of Food Intake on the Healing Process of Postoperative Pancreatic Fistula After Pancreatoduodenectomy: A Multi-institutional Randomized Controlled Trial. Ann. Surg. Oncol. 2015, 22, 3905–3912. [Google Scholar] [CrossRef] [PubMed]
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MUST = 0 | Control and observation by the department of oncology or surgery. | MUST = 0 (no risk of malnutrition). Nutritional assessment every 2 months to check whenever there are any clinical changes that may adversely affect the nutritional status of patients. |
MUST = 1 | Nutritional control and treatment by the department responsible for the treatment of patients, starting with nutritional counseling and oral nutritional supplements (ONSs). The patient must be periodically reassessed. | MUST = 1 (moderate risk of malnutrition): assess nutritional status within 2–3 weeks. |
MUST ≥ 2 | The patient must be referred to the nutrition department. | MUST ≥ (high risk of malnutrition): assessment within 5–7 days. |
Nutrition Risk Score—NRS 2002 |
The test consists of the evaluation of four elements: Is the patient’s BMI below 20.5? Has the patient lost weight in the last 3 months? Has the patient eaten less in the last week? Is the patient in a serious condition (e.g., in the intensive care unit)? |
If the answer to any question is positive, proceed to the second part of the study. If all answers are negative, the examination should be performed in a week. |
NRS 2002 Part 2 |
One appropriate degree of nutritional status disorder and disease severity should be selected. If the sum of the points is: ≥3—the treating physician should be notified, and a nutritional intervention should be implemented. ≤3—malnutrition is unlikely; repeat assessment in 7 days. |
Subjective Global Assessment—SGA |
The test consists of evaluating the following elements:
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If the SGA result is A, the assessment should be carried out in a week; if the SGA result is B or C, then detailed assessment of the nutritional status should be performed immediately. |
Author | Year | Methodology | Results | Conclusions |
---|---|---|---|---|
Kato et al. [44] | 2018 | Retrospective studies | The high-risk CONUT group had significantly lower overall survival than the low-risk CONUT group. The CONUT score had an independent relationship with overall survival. The CONUT score showed no association with postoperative pancreatic fistula or postoperative hospitalization. | The CONUT score was independently associated with survival in patients with PDAC after pancreatectomy and was not associated with recurrence or postoperative complications. |
Menozzi et al. [45] | 2023 | Retrospective studies | Weight loss affected postoperative morbidity/mortality, and decreased muscle mass was an independent predictor of postoperative peptic hemorrhage. There was no relationship between the parameters of nutritional status before surgery and the length of hospitalization, 30-day re-intervention, pancreatic fistula, biliary fistula, and delayed gastric emptying. | Impaired nutritional status prior to pancreatic surgery affects many postoperative outcomes. Measurement of nutritional status supported by CT analysis of body composition parameters, especially muscle mass, should be the gold standard of preoperative assessment in order to obtain early and appropriate nutritional support. |
Vashi et al. [46] | 2015 | Retrospective studies | SGA was an independent predictor of survival. Patients with lower SGA had a risk of death that was 1.5 times greater than that of patients with higher SGA. | The improvement in SGA during PC treatment was correlated with a significantly reduced risk of mortality regardless of gender, history of prior treatment, and evidence of antitumor biological activity. Maintaining or improving nutritional status during pancreatic cancer treatment was associated with better outcomes. |
Zhou et al. [47] | 2022 | Prospective studies | Phase angle (PhA) value: The values in the nutritional risk group and the malnourished group were significantly lower than those in the properly nourished group. PhA was positively correlated with nutritional status. The PhA value of the group with postoperative complications was significantly lower than that of the group without complications. | PhA was associated with nutritional status and can be considered a tool for assessing nutritional status in patients with pancreatic head cancer and predicting postoperative complications in patients who have undergone PD. |
Mao et al. [48] | 2020 | Retrospective studies | Both a low PNI (≤45) and a high CONUT (≥3) were independent risk factors for poor overall survival. CONUT may have greater sensitivity and specificity in predicting complications and survival. | Preoperative low PNI (≤45) and high CONUT scores (≥3) may be reliable predictors of prognosis and surgical complications in patients with PDAC. Compared to PNI, CONUT can be more effective. |
Phillips et al. [49] | 2022 | Systematic review | Studies were mainly limited by retrospective designs. A meta-analysis could not be performed due to heterogeneity in study design and reporting methods. Patients with PC had a deterioration of their nutritional status, and 44–63% of patients undergoing neoadjuvant chemotherapy had low muscle mass before starting treatment. | There is a shortage of data on nutritional intervention in pancreatic cancer. Future work should include the use of validated functional and clinical assessment tools to further explore the impact of nutritional intervention and the relationship between nutritional status and outcomes. |
Jabłońska et al. [50] | 2021 | Retrospective studies | Higher nutritional risk according to NRS 2002 was significantly associated with older age, greater weight loss, lower BMI, lower total lymphocyte count, longer hospitalization, neoadjuvant chemotherapy, and preoperative biliary drainage. Low PNI was significantly associated with greater body weight loss, lower total serum protein and albumin concentrations and lymphocyte counts, higher neutrophil/lymphocyte counts (NLR), and length of hospitalization. | Eating disorders were correlated with a systemic inflammatory response in PC patients. Obesity (BMI ≥ 30 kg/m2) and malnutrition (NRS 2002 ≥ 3) predicted postoperative complications that were associated with a longer hospitalization. |
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Share and Cite
Mękal, D.; Sobocki, J.; Badowska-Kozakiewicz, A.; Sygit, K.; Cipora, E.; Bandurska, E.; Czerw, A.; Deptała, A. Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer. Cancers 2023, 15, 3816. https://doi.org/10.3390/cancers15153816
Mękal D, Sobocki J, Badowska-Kozakiewicz A, Sygit K, Cipora E, Bandurska E, Czerw A, Deptała A. Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer. Cancers. 2023; 15(15):3816. https://doi.org/10.3390/cancers15153816
Chicago/Turabian StyleMękal, Dominika, Jacek Sobocki, Anna Badowska-Kozakiewicz, Katarzyna Sygit, Elżbieta Cipora, Ewa Bandurska, Aleksandra Czerw, and Andrzej Deptała. 2023. "Evaluation of Nutritional Status and the Impact of Nutritional Treatment in Patients with Pancreatic Cancer" Cancers 15, no. 15: 3816. https://doi.org/10.3390/cancers15153816