General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy.
Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy.
Nutrients. 2021 May 22;13(6):1765. doi: 10.3390/nu13061765.
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.
全胰切除术（TP）是一种高度侵袭性的手术，通常在患有厌食、吸收不良、恶病质和营养不良的患者中进行，这些都是手术结果不良的风险因素，甚至可能增加化疗和放疗的毒性。一些研究描述了营养治疗的作用以及营养方面与接受 TP 治疗的患者结局之间的关系。本综述的目的是总结有关 TP 中营养因素影响的现有最新证据。分析了术前营养和代谢评估以及术中术后营养治疗及其后果，以确定可能影响接受 TP 治疗的患者结局的因素。本综述的结果表明，术前营养状况、肌肉减少症、BMI 和血清白蛋白既是胰腺癌行 TP 联合化疗以支持治疗、预防复发和延长生存的预后因素，也是慢性胰腺炎行 TP 联合胰岛自体移植以改善术后血糖控制和获得更好结局的预后因素。只要有可能，肠内营养总是优于肠外营养，目的是预防或减少恶病质。如今，TP 的营养后果，包括糖尿病控制，得到了改善，并且变得更容易管理。
