Recent Advances in Pancreatic Ductal Adenocarcinoma: Strategies to Optimise the Perioperative Nutritional Status in Pancreatoduodenectomy Patients

Simple Summary: Pancreatic cancer is an aggressive cancer, and the surgery to remove it carries significant risks. If patients undergo successful surgery, then they will require chemotherapy to stop the cancer from coming back. Poor nutrition increases the risks of surgery and reduces the number of patients that can have chemotherapy. In this article, we describe various strategies that can improve the nutrition of these patients before, during, and after surgery so as to lead to the best treatment outcomes. We also describe areas in this field that will benefit from future research so that we can continue to improve the treatment outcomes for this vulnerable patient group.

Abstract: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy for which the mainstay of treatment is surgical resection, followed by adjuvant chemotherapy. Patients with PDAC are disproportionately affected by malnutrition, which increases the rate of perioperative morbidity and mortality, as well as reducing the chance of completing adjuvant chemotherapy. This review presents the current evidence for pre-, intra-, and post-operative strategies to improve the nutritional status of PDAC patients. Such preoperative strategies include accurate assessment of nutritional status, diagnosis and appropriate treatment of pancreatic exocrine insufficiency, and prehabilitation. Postoperative interventions include accurate monitoring of nutritional intake and proactive use of supplementary feeding methods, as required. There is early evidence to suggest that perioperative supplementation with immunonutrition and probiotics may be beneficial, but further study and understanding of the underlying mechanism of action are required.