Perioperative Nutritional Aspects in Total Pancreatectomy: A Comprehensive Review of the Literature |
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| Authors: | Niccolò Furbetta,Annalisa Comandatore,Desiré e Gianardi,Matteo Palmeri,Gregorio Di Franco,Simone Guadagni,Giovanni Caprili,Matteo Bianchini,Lorenzo Maria Fatucchi,Martina Picchi,Luca Bastiani,Giandomenico Biancofiore,Giulio Di Candio,Luca Morelli |
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| Affiliation: | 1.General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy; (N.F.); (A.C.); (D.G.); (M.P.); (G.D.F.); (S.G.); (G.C.); (M.B.); (L.M.F.); (M.P.); (G.D.C.);2.Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy;3.Division of Transplant Anesthesia and Critical Care, University of Pisa, 56124 Pisa, Italy; |
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| Abstract: | Total pancreatectomy (TP) is a highly invasive procedure often performed in patients affected by anorexia, malabsorption, cachexia, and malnutrition, which are risk factors for bad surgical outcome and even may cause enhanced toxicity to chemo-radiotherapy. The role of nutritional therapies and the association between nutritional aspects and the outcome of patients who have undergone TP is described in some studies. The aim of this comprehensive review is to summarize the available recent evidence about the influence of nutritional factors in TP. Preoperative nutritional and metabolic assessment, but also intra-operative and post-operative nutritional therapies and their consequences, are analyzed in order to identify the aspects that can influence the outcome of patients undergoing TP. The results of this review show that preoperative nutritional status, sarcopenia, BMI and serum albumin are prognostic factors both in TP for pancreatic cancer to support chemotherapy, prevent recurrence and prolong survival, and in TP with islet auto-transplantation for chronic pancreatitis to improve postoperative glycemic control and obtain better outcomes. When it is possible, enteral nutrition is always preferable to parenteral nutrition, with the aim to prevent or reduce cachexia. Nowadays, the nutritional consequences of TP, including diabetes control, are improved and become more manageable. |
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| Keywords: | total pancreatectomy total pancreatectomy with islet auto-transplantation nutrition nutritional status nutritional support |
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