There are many publications on dietary or nutritional risk factors for developing cancer or carcinoma. But there are only few recommendations for post-treatment nutrition, mostly in colorectal cancer. But I didn't find specific recommendations for post-treatment nutrition for people with diabetes mellitus and pancreatic carcinoma.
Dear Dr Krichbaumn
I suppose this paper is interesting
Int J Surg. 2016 Jul;31:93-9. doi: 10.1016/j.ijsu.2016.05.071. Epub 2016 Jun 3.
Preoperative oral immunonutrition versus standard preoperative oral diet in well nourished patients undergoing pancreaticoduodenectomy.
Silvestri S1, Franchello A2, Deiro G3, Galletti R4, Cassine D5, Campra D6, Bonfanti D7, De Carli L8, Fop F9, Fronda GR10.
Author information
Abstract
BACKGROUND:
Pancreaticoduodenectomy is still associated to high morbility, especially due to pancreatic surgery related and infectious complications: many risk factors have already been advocated. Aim of this study is to evaluate the role of preoperative oral immunonutrition in well nourished patients scheduled for pancreaticoduodenectomy.
METHODS:
From February 2014 to June 2015, 54 well nourished patients undergoing pancreaticoduodenectomy were enrolled for 5 days preoperative oral immunonutrition. A series of consecutive patients submitted to the same intervention in the same department, with preoperative standard oral diet, was matched 1:1. For analysis demographic, pathological and surgical variables were considered. Mortality rate, overall postoperative morbility, pancreatic fistula, post pancreatectomy haemorrhage, delayed gastric emptying, infectious complications and length of hospital stay were described for each groups. Chi squared test, Fisher's Exact test and Student's T test were used for comparison. Differences were considered statistically significant at p < 0.05. Statistics was performed using a freeware Microsoft Excel (®) based program and SPSS v 10.00.
RESULTS:
No statistical differences in term of mortality (2.1% in each groups) and overall morbility rate (41.6% vs 47.9%) occurred between the groups as well as for pancreatic surgery related complications. Conversely, statistical differences were found for infectious complications (22.9% vs 43.7%, p = 0.034) and length of hospital stay (18.3 ± 6.8 days vs 21.7 ± 8.3, p = 0.035) in immunonutrition group.
CONCLUSION:
Preoperative oral immunonutrition is effective for well nourished patients scheduled for pancreaticoduodenectomy; it helps to reduce the risk of postoperative infectious complications and length of hospital stays.
Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:
Hospital stay; Immunonutrition; Infectious complications; Pancreaticoduodenectomy; Preoperative nutrition
PMID: 27267949 DOI: 10.1016/j.ijsu.2016.05.071
Well I suppose fat and protein restriction should be primary as these are chiefly digested by pancreatic enzymes. Alcohol in any amount is "poison" for these patients. Pancreatic enzyme supplementation may be necessary and diabetes may get worse if tail of pancreas is removed so diet for proper diabetes control is also needed.
Dear Gautam Ray, Thanks for your proposals. These recommendations correspond to the general proposals, which can be found on clinic websites and in patient brochures. They are logical and common sense, but is there any evidence by clinical studies or are there published guidelines? Best, Michael
We recommend the same food as for people with Diabetes type 1, without any Special restriction of fat or Protein.
Dear Habibollah Mahmoodzadeh, Thanks for the tip on this paper which seems to be interesting to this topic in general. But it does not fit to my question. I search for specific post-operative dietary recommendations not for pre-operative recommendations. We have no surgery unit in our clinic and no patients who will undergo this operation. But we have more patients each year who have already undergone this surgical operation and who have subsequently developed diabetes. Best, Michael
Dear Dr. Müller, Thanks for this information. Friendly greetings to Jena, Michael Krichbaum
Recommendations: All amino acids containing sulfur. And ketogenic nutrition.
Most studies address pre and perioperative nutrition with general overview of postop nutrition in such cases which includes diabetes. The following articles might be of help
[1] Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection. Nutrients 2017, 9, 243; doi:10.3390/nu9030243
[2] Pancreatic Resection: Nutritional Implications and Long Term Follow Up. PRACTICAL GASTROENTEROLOGY • MARCH 2016
[3] John A Stauffer. Patient outcomes after total pancreatectomy: a single centre contemporary experience. HPB (Oxford). 2009 Sep; 11(6): 483–492.
Dear Gautam Ray, many thanks for this information. I did not know the articles from Gilliland [1] and Phillips [2] before. They are very helpful. Best wishes, Michael
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