Nutritional Challenges in Patients Post-Whipple Surgery
Nutrition is a critical factor to consider both in the pre- and postoperative period for patients undergoing a Whipple procedure.
At the time of diagnosis, patients with pancreatic cancer are often faced with a multitude of treatment options, including surgery. Nutrition is an important preoperative factor when evaluating a patient for a surgery, though postoperative nutritional status can also be vital and is an often under-valued part of the patient's overall medical plan.
One surgical approach to pancreatic cancer involves the “Whipple” procedure, which is considered the conventional pancreaticoduodenectomy (PD).
The Whipple procedure involves the surgical removal of the following parts of the gastrointestinal tract: head of pancreas, duodenum, proximal portion of the jejunum, common bile duct, gallbladder, and a partial gastrectomy.1 The best outcomes for patients undergoing a Whipple procedure are typically at facilities with high volumes and from surgeons with extensive experience.2
Post-operative nutrition is extremely important for a patient undergoing a Whipple procedure both in the short- and long-term follow up.
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A systematic review included close to 3500 patients from 15 studies; this review focused on post-PD patients receiving nutrition orally, enterally (nasojejunal tube, gastrojejunostomy tube, jejunostomy tube), or via total parenteral nutrition (TPN).3 No significant differences in outcomes between the nutritional groups were found, and the authors recommended that oral intake be the preferred strategy after PD.
Yet close to 30% of patients who received oral feedings still required nutritional support at some point either because of inadequate intake or postoperative complications.