Recent Advances in Pancreatic Ductal Adenocarcinoma: Strategies to Optimise the Perioperative Nutritional Status in Pancreatoduodenectomy Patients

Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy for which the mainstay of treatment is surgical resection, followed by adjuvant chemotherapy. Patients with PDAC are disproportionately affected by malnutrition, which increases the rate of perioperative morbidity and mortality, as well as reducing the chance of completing adjuvant chemotherapy. This review presents the current evidence for pre-, intra-, and post-operative strategies to improve the nutritional status of PDAC patients. Such preoperative strategies include accurate assessment of nutritional status, diagnosis and appropriate treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions include accurate monitoring of nutritional intake and proactive use of supplementary feeding methods, as required. There is early evidence to suggest that perioperative supplementation with immunonutrition and probiotics may be beneficial, but further study and understanding of the underlying mechanism of action are required.

Automated summary

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer with surgical resection as the main treatment followed by adjuvant chemotherapy. Malnutrition is common in PDAC patients, leading to increased perioperative complications, mortality, and reduced completion of adjuvant chemotherapy. This review discusses current strategies to improve the nutritional status of PDAC patients, including accurate assessment of nutritional status, treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions involve monitoring nutritional intake and proactive use of supplementary feeding methods. Early evidence suggests potential benefits of perioperative supplementation with immunonutrition and probiotics, but further research and understanding of their mechanisms of action are needed.