Department of Nutrition and Dietetics, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
J Hum Nutr Diet. 2023 Apr;36(2):493-503. doi: 10.1111/jhn.13040. Epub 2022 Jun 28.
There is an urgent need to identify and treat potentially modifiable factors that may improve quality of life and influence survival of people with pancreatic cancer. The present study aimed to assess nutritional status at diagnosis and in the early and later stages of postoperative recovery and to evaluate the feasibility of optimising nutritional status and symptoms in patients undergoing surgery, as part of a multidisciplinary prehabilitation intervention.
Nutritional data collection and intervention took place at four time points: (1) baseline at diagnosis; (2) prior to surgery; (3) first postoperative review (within 6 weeks); and (4) at 6-12 months postoperatively. The 'Patient Generated Subjective Global Assessment' (PG-SGA) tool was used to undertake a detailed nutritional assessment and the modified 'Gastrointestinal Symptom Rating Scale' (GISRS) was completed for all patients. Handgrip strength was measured by dynamometry.
During the period between April 2016 and April 2018, 137 patients scheduled for pancreatic cancer surgery were included who had a baseline dietetic assessment and at least one further review. Baseline assessment demonstrated that malnutrition was highly prevalent, with 62.3% experiencing more than 5% and 29.2% experiencing more than 10% weight loss over the prior 6 months. With dietetic assessment and support for at least 14 days, these patients gained a mean 1.8% body weight during this period and a mean improved handgrip of 7.9%. Symptoms also improved, with absolute change in PG-SGA scores reduced by a mean of 6.19 and a 6.3 reduction of GISRS.
Dietetic assessment and intervention for all patients undergoing pancreatic resection ensures timely identification of nutritional deficiencies and correction of avoidable causes of weight loss, such as pancreatic enzyme insufficiency.
迫切需要识别和治疗可能改善生活质量并影响胰腺癌患者生存的可改变因素。本研究旨在评估诊断时以及术后早期和晚期的营养状况，并评估对接受手术的患者进行优化营养状况和症状的可行性，作为多学科预康复干预的一部分。
营养数据收集和干预发生在四个时间点：（1）诊断时的基线；（2）手术前；（3）第一次术后复查（6 周内）；和（4）术后 6-12 个月。使用“患者生成的主观整体评估”（PG-SGA）工具进行详细的营养评估，所有患者均完成改良的“胃肠道症状评分量表”（GISRS）。握力通过测力计测量。
在 2016 年 4 月至 2018 年 4 月期间，纳入了 137 名计划接受胰腺癌手术的患者，他们进行了基线饮食评估并进行了至少一次进一步的评估。基线评估表明，营养不良非常普遍，62.3%的患者体重减轻超过 5%，29.2%的患者体重减轻超过 10%。在过去的 6 个月中，通过饮食评估和至少 14 天的支持，这些患者的体重平均增加了 1.8%，握力平均提高了 7.9%。症状也有所改善，PG-SGA 评分的绝对变化平均降低了 6.19，GISRS 降低了 6.3。
对所有接受胰腺切除术的患者进行饮食评估和干预可确保及时发现营养不足，并纠正可避免的体重减轻原因，如胰腺酶不足。
