Pancreatic cancer surgery and nutrition management: a review of the current literature

Surgery remains the only curative treatment for pancreaticobiliary tumors. These patientstypically present in a malnourished state. Various screening tools have been employed to help withpreoperative risk stratification. Examples include the subjective global assessment (SGA), malnutritionuniversal screening tool (MUST), and nutritional risk index (NRI). Adequate studies have not beenperformed to determine if perioperative interventions, based on nutrition risk assessment, result in lessmorbidity and mortality. The routine use of gastric decompression with nasogastric sump tubes may beunnecessary following elective pancreatic resections. Instead, placement should be selective and employedon a case-by-case basis. A wide variety of feeding modalities are available, oral nutrition being the mosteffective. Artificial nutrition may be provided by temporary nasal tube (nasogastric, nasojejunal, or combinednasogastrojejunal tube) or surgically placed tube [gastrostomy (GT), jejunostomy (JT), gastrojejunostomytubes (GJT)], and intravenously (parenteral nutrition, PN). The optimal tube for enteral feeding cannot bedetermined based on current data. Each is associated with a specific set of complications. Dual lumen tubesmay be useful in the presence of delayed gastric emptying (DGE) as the stomach may be decompressedwhile feeds are delivered to the jejunum. However, all feeding tubes placed in the small intestine, exceptdirect jejunostomies, commonly dislodge and retroflex into the stomach. Jejunostomies are associated withless frequent, but more serious complications. These include intestinal torsion and bowel necrosis. PN isassociated with septic, metabolic, and access-related complications and should be the feeding strategy of lastresort.Enteral feeds are clearly preferred over parental nutrition. A sound understanding of perioperativenutrition may improve patient outcomes. Patients undergoing pancreatic cancer surgery should undergomultidisciplinary nutrition screening and intervention, and the surgical/oncological team should includenutrition professionals in managing these patients in the perioperative period.