Update on the nutritional management of patients with pancreatic ductal adenocarcinoma: a literature review

Abstract

Introduction: pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Only 20% of patients are operable at the time of diagnosis. However, the survival rate varies between patients depending on immune response and nutritional status. Weight loss is frequent and multifactorial, so anorexia-cachexia syndrome and exocrine pancreatic insufficiency (EPI) should be considered. It is essential to carry out the nutritional care process in all cases from the moment of the diagnostic suspicion and during the disease. The management of patients with PDAC requires a personalized approach, individualizing behaviors, and from a multidisciplinary perspective at each stage of the disease. The aim of this review is to describe the most appropriate nutritional strategies to improve the quality of care for patients with PDAC.

Materials and method: a narrative review was carried out by implementing a bibliographic search through the electronic databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), via PUBMED and Cochrane Library. Search criteria were used in Spanish and English: pancreatic ductal adenocarcinoma; nutritional assessment; malnutrition; nutritional therapy; body composition; toxicity; exocrine pancreatic insufficiency and pancreatic surgery. Original articles, narrative and systematic reviews, clinical practice guidelines, randomized controlled studies in adults ≥18 years, published between January 2017 and February 2024, were included.

Results: PDAC is one of the most lethal malignancies; between 80 and 85% of patients have advanced disease at the time of diagnosis. Early detection and nutritional risk are important to identify patients with malnutrition, optimize preparation for surgery, minimize perioperative risks, and offer better nutritional recovery through different nutritional interventions. Nutritional counseling and nutritional therapy decrease the toxicity of treatment, improve intake and nutritional status, as well as the patient’s quality of life. Pancreatic surgery, and the complications that come with it, including exocrine pancreatic insufficiency, lead to calorie-protein malnutrition and vitamin deficits.

Conclusion: malnutrition is a common feature in patients with PDAC, which increases treatment-related complications. The management of patients with PDAC should be personalized, individualizing behaviors and from a multidisciplinary perspective, which should include a specialized Nutrition graduate.