Effect of early enteral nutrition on postoperative outcomes in pancreatic cancer patients with diabetes.
Efecto de la nutrición enteral temprana en los resultados postoperatorios en pacientes con cáncer de páncreas y diabetes.
Palabras clave:
diabetes mellitus, nutrición enteral temprana, función gastrointestinal, cáncer de páncreas
Resumen
Este estudio tuvo como objetivo evaluar el impacto del apoyo nutricional enteral temprano en pacientes con cáncer de páncreas y diabetes mellitus después de una pancreatectomía total. Noventa y seis pacientes fueron divididos aleatoriamente en grupos de control y de investigación, cada uno con 48 pacientes. Ambos grupos recibieron nutrición parenteral, mientras que el grupo de investigación recibió nutrición enteral adicional dentro de las primeras 48 horas posteriores a la cirugía. Los resultados mostraron que el grupo de investigación experimentó una recuperación más rápida de los ruidos intestinales, una primera defecación más temprana y tiempos de retención del tubo gástrico más cortos en comparación con el grupo de control (p<0,05). La función gastrointestinal posoperatoria, la función inmunológica y el estado nutricional fueron significativamente mejores en el grupo de investigación, con niveles más altos de gastrina, motilina, inmunoglobulinas G, A y M, relación CD4/CD8, albúmina, prealbúmina y transferrina (p<0,05). Además, el grupo de investigación tuvo un mejor control de la glucemia desde las 48 horas hasta los siete días posteriores a la cirugía (p<0,05). Los resultados anteriores demostraron un efecto promotor del apoyo nutricional temprano en la recuperación de la función física posoperatoria de pacientes con cáncer de páncreas y diabetes mellitus. En conclusión, el apoyo nutricional enteral temprano en pacientes con cáncer de páncreas y diabetes mellitus mejoró significativamente el estado nutricional, la recuperación gastrointestinal posoperatoria, la función gastrointestinal e inmunitaria y el control de la glucemia, lo que condujo a un mejor pronóstico general.
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Zhong PS, Nakata K, Oyama K, Higashijima N, Sagara A, Date S, Luo H, Hayashi M, Kubo A, Wu C, He S Blockade of histamine receptor H1 augments immune checkpoint therapy by enhancing MHC-I expression in pancreatic cancer cells. J Exp Clin Cancer Res 2024; 43(1): 138. https://doi.org/10.1186/s13046-024-03060-5.
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Imamura S, Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Yoshida Y, Taketomo Y, Yoshida S, Takeyama Y, Noso S. High incidence of diabetes mellitus after distal pancreatectomy and its predictors: A long-term follow-up study. J Clin Endocrinol Metab 2024; 109(3): 619-630. https://doi.org/10.1210/clinem/dgad634.
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Drougkas K, Karampinos K, Karavolias I, Gomatou G, Koumprentziotis IA, Ploumaki I, Triantafyllou E, Kotteas E. CAR-T Cell therapy in pancreatic and biliary tract cancers: An updated review of clinical trials. J Gastrointest Cancer 2024; 55(3):990-1003. https://doi.org/10.1007/s12029-024-01054-2.
Hodzic E, Pusina S, Salibasic M, Rovcanin A, Halilovic E, Herenda N. Impact of different surgical approaches on morbidity and mortality in patients with borderline resectable pancreatic head carcinoma. Med Arch (Sarajevo, Bosnia Herzegovina) 2024; 78(1): 29-32. https://doi.org/10.5455/medarh.2024.78.29-32.
Aoyama T, Hashimoto I, Maezawa Y, Hara K, Kato A, Kazama K, Tamagawa A, Cho H, Nakazono M, Numata M, Kawahara S. The prognostic immune and nutritional indices are independent prognostic factors for esophageal cancer patients who receive curative treatment. Anticancer Res 2024; 44(5): 2185-2192. https://doi.org/10.21873/ANTICANRES.17025.
Mękal D, Sobocki J, Badowska-Kozakiewicz A, Sygit K, Cipora E, Bandurska E, Czerw A, Deptała A. Evaluation of nutritional status and the impact of nutritional treatment in patients with pancreatic cancer. Cancers (Basel). 2023 Jul 27;15(15):3816. https://doi: 10.3390/cancers15153816.
Bouloubasi Z, Karayiannis D, Pafili Z, Almperti A, Nikolakopoulou K, Lakiotis G, Stylianidis G, Vougas V. Re-assessing the role of peri-operative nutritional therapy in patients with pancreatic cancer undergoing surgery: A narrative review. Nutr Res Rev 2024; 37(1): 121-130. https://doi.org/10.1017/S0954422423000100.
Yamamoto N, Aoyama T, Murakawa M, Kamiya M, Shiozawa M, Rino Y, Masuda M, Morinaga S. Outcomes of feeding jejunostomy after pancreaticoduodenectomy: A single-center experience. J Cancer Res Ther 2022; 18(9): 444-448. https://doi. org/10.4103/jcrt.JCRT_1655_20.
Hamaker ME, Oosterlaan F, van Huis LH, Thielen N, Vondeling A, van den Bos F. Nutritional status and interventions for patients with cancer - A systematic review. J Geriatr Oncol. 2021;12(1):6-21. https://doi:doi:10.1016/j.jgo.2020.06.020.
Takeda Y, Mise Y, Kishi Y, Sugo H, Kyoden Y, Hasegawa K, Takahashi Y, Saiura Enteral versus parental nutrition after pancreaticoduodenectomy under enhanced recovery after surgery protocol: study protocol for a multicenter, open-label randomized controlled trial (ENE-PAN trial). Trials 2022; 23(1): 917. https://doi.org/10.1186/s13063-022-06856-y.
Yuan J, Xiu D. Effects of early enteral nutrition on pancreatic fistula and long-term prognosis after distal pancreatectomy or enucleation of pancreatic tumours in a major academic university hospital in China: protocol for a single-centre randomised controlled trial. BMJ Open. 2023 Aug 10;13(8):e068469. https://doi: 10.1136/ bmjopen-2022-068469.
Schiessel DL, Orrutéa AKG, Tramontt C, Cavagnari MAV, Novello D, Macedo DS. Clinical and nutritional characteristics on overall survival impact in patients with gastrointestinal cancer. Clin Nutr ESPEN 2022; 48: 336-341. https://doi.org/10.1016/j.clnesp.2022.01.021.
Chakaroun RM, Massier L, Kovacs P. Gut Microbiome. Intestinal permeability, and tissue bacteria in metabolic disease: perpetrators or bystanders? Nutrients. 2020 Apr 14;12(4):1082. https://doi: 10.3390/ nu12041082.
Jabłońska B, Mrowiec S. The role of immunonutrition in patients undergoing pancreaticoduodenectomy. Nutrients 2020; 12(9). https://doi.org/10.3390/nu12092547.
Cresci GAM, Lampe JW, Gibson G. Targeted approaches for in situ gut microbiome manipulation. J Parenter Enter Nutr 2020; 44(4): 581-588. https://doi.org/10.1002/jpen.1779.
Yamamoto J, Onodera H, Kaminaga Y, Kayaba Y, Usui M. Anamorelin lnduced acute hyperglycemia in a patient with advanced pancreatic cancer and diabetes: A Case Report. Tohoku J Exp Med 2024; 262(4): 263-268. https://doi.org/10.1620/tjem.2024. J013.
Liu F, Xiao Z, Zeng H, Li J, Ai F, Qi J. Early enteral nutrition with fructooligo- saccharides improves prognosis in severe acute pancreatitis. Sci Rep. 2025 Feb 12;15(1):5267. https://doi: 10.1038/s41598-025-89739-x.
Zhong PS, Nakata K, Oyama K, Higashijima N, Sagara A, Date S, Luo H, Hayashi M, Kubo A, Wu C, He S Blockade of histamine receptor H1 augments immune checkpoint therapy by enhancing MHC-I expression in pancreatic cancer cells. J Exp Clin Cancer Res 2024; 43(1): 138. https://doi.org/10.1186/s13046-024-03060-5.
Aziret M, Aşıkuzunoğlu F, Altıntoprak F, Tozlu M, Demirci A, Ercan M, Saydan D, Küçük Aİ. Early and long-term morbidity and mortality following pancreaticoduodenectomy for periampullary tumors in elderly patients. Ann Ital Chir 2024; 95(2): 235-245. https://doi.org/10.62713/aic.3380.
Yan T, Tang G, Zhang H, Liang L, Ma J, Gao Y, Zhou C, Li S. Multiscale and multiperception feature learning for pancreatic lesion detection based on noncontrast CT. Phys Med Biol 2024; 69(10). https://doi.org/10.1088/1361-6560/ad3c0c.
Zhu T, Chen Q, Chen H, You L, Liu D, Zhang X, Li F, Wu H, Tang J, Lin D, Sun K. Independent and interactive associations of heart rate and obesity with type 2 diabetes mellites: A population-based study. J Diabetes 2024; 16(4): e13529. https://doi.org/10.1111/1753-0407.13529.
Wang H, Ruan S, Wu Z, Yan Q, Chen Y, Cui J, Zhang Z, Huang S, Hou B, Zhang C. Prognostic significance of glucose-lipid metabolic index in pancreatic cancer patients with diabetes mellitus. Cancer Med 2024; 13(6): e7108. https://doi.org/10.1002/cam4.7108.
Mita J, Maeda T, Tsujita E, Hashimoto N, Fujikawa R, Ono Y, Sakai A, Tanaka S, Matono R, Ohmine T, Kometani T. Skeletal muscle mass index reduction rate as a prognostic indicator for patients undergoing pancreatectomy for pancreatic cancer. Cancer diagnosis Progn 2024; 4(3): 301-308. https://doi.org/10.21873/cdp.10324.
Dong J, Yu J, Li Z, Gao S, Wang H, Yang S, Wu L, Lan C, Zhao T, Gao C, Liu Z. Serum insulin-like growth factor binding protein 2 levels as biomarker for pancreatic ductal adenocarcinoma-associated malnutrition and muscle wasting. J Cachexia Sarcopenia Muscle 2021; 12(3): 704-716. https://doi.org/10.1002/jcsm.12692.
Aziz MH, Van Der Meulen J, Mustafa DAM, Van Eijck CHJ. Fat-soluble vitamin deficiencies and disruption of the immune system in pancreatic cancer: A vicious cycle. Pancreas 2022; 51(8): 923-929. https://doi.org/10.1097/MPA.0000000000002128.
Chen L, Huang Z, Tian Q, Zha Q, Zhang S, Chen Z, Dong Z, Zhou Y, Zhang M, Wei X. Construction of individualised care programmes for patients with pancreatic cancer with postoperative weight-loss control based on the Delphi method: a cross-sectional study in China. J Heal Popul Nutr 2024; 43(1): 36. https://doi.org/10.1186/ s41043-024-00525-3.
Abe K, Uwagawa T, Hamura R, Shirai Y, Yasuda J, Furukawa K, Shiozaki H, Onda S, Gocho T, Ikegami T. Effects of an enteral nutrient-rich therapy with omega-3 fatty acids in patients with unresectable or recurrent biliary tract cancer or pancreatic cancer during chemotherapy: a case-control study. Med Oncol 2022; 39(5): 66. https://doi.org/10.1007/s12032-021-01625-4.
Imamura S, Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Yoshida Y, Taketomo Y, Yoshida S, Takeyama Y, Noso S. High incidence of diabetes mellitus after distal pancreatectomy and its predictors: A long-term follow-up study. J Clin Endocrinol Metab 2024; 109(3): 619-630. https://doi.org/10.1210/clinem/dgad634.
Xiao G, Wei Y, Xie R, Tsang Y, Gu J, Shen D, Ding M, Yuan J, Xu D, Fei J. Citric acid promotes SPARC release in pancreatic cancer cells and inhibits the progression of pancreatic tumors in mice on a high-fat diet. FEBS J 2024; 291(8): 1699-1718. https://doi.org/10.1111/febs.17058.
Drougkas K, Karampinos K, Karavolias I, Gomatou G, Koumprentziotis IA, Ploumaki I, Triantafyllou E, Kotteas E. CAR-T Cell therapy in pancreatic and biliary tract cancers: An updated review of clinical trials. J Gastrointest Cancer 2024; 55(3):990-1003. https://doi.org/10.1007/s12029-024-01054-2.
Hodzic E, Pusina S, Salibasic M, Rovcanin A, Halilovic E, Herenda N. Impact of different surgical approaches on morbidity and mortality in patients with borderline resectable pancreatic head carcinoma. Med Arch (Sarajevo, Bosnia Herzegovina) 2024; 78(1): 29-32. https://doi.org/10.5455/medarh.2024.78.29-32.
Aoyama T, Hashimoto I, Maezawa Y, Hara K, Kato A, Kazama K, Tamagawa A, Cho H, Nakazono M, Numata M, Kawahara S. The prognostic immune and nutritional indices are independent prognostic factors for esophageal cancer patients who receive curative treatment. Anticancer Res 2024; 44(5): 2185-2192. https://doi.org/10.21873/ANTICANRES.17025.
Mękal D, Sobocki J, Badowska-Kozakiewicz A, Sygit K, Cipora E, Bandurska E, Czerw A, Deptała A. Evaluation of nutritional status and the impact of nutritional treatment in patients with pancreatic cancer. Cancers (Basel). 2023 Jul 27;15(15):3816. https://doi: 10.3390/cancers15153816.
Bouloubasi Z, Karayiannis D, Pafili Z, Almperti A, Nikolakopoulou K, Lakiotis G, Stylianidis G, Vougas V. Re-assessing the role of peri-operative nutritional therapy in patients with pancreatic cancer undergoing surgery: A narrative review. Nutr Res Rev 2024; 37(1): 121-130. https://doi.org/10.1017/S0954422423000100.
Yamamoto N, Aoyama T, Murakawa M, Kamiya M, Shiozawa M, Rino Y, Masuda M, Morinaga S. Outcomes of feeding jejunostomy after pancreaticoduodenectomy: A single-center experience. J Cancer Res Ther 2022; 18(9): 444-448. https://doi. org/10.4103/jcrt.JCRT_1655_20.
Hamaker ME, Oosterlaan F, van Huis LH, Thielen N, Vondeling A, van den Bos F. Nutritional status and interventions for patients with cancer - A systematic review. J Geriatr Oncol. 2021;12(1):6-21. https://doi:doi:10.1016/j.jgo.2020.06.020.
Takeda Y, Mise Y, Kishi Y, Sugo H, Kyoden Y, Hasegawa K, Takahashi Y, Saiura Enteral versus parental nutrition after pancreaticoduodenectomy under enhanced recovery after surgery protocol: study protocol for a multicenter, open-label randomized controlled trial (ENE-PAN trial). Trials 2022; 23(1): 917. https://doi.org/10.1186/s13063-022-06856-y.
Yuan J, Xiu D. Effects of early enteral nutrition on pancreatic fistula and long-term prognosis after distal pancreatectomy or enucleation of pancreatic tumours in a major academic university hospital in China: protocol for a single-centre randomised controlled trial. BMJ Open. 2023 Aug 10;13(8):e068469. https://doi: 10.1136/ bmjopen-2022-068469.
Schiessel DL, Orrutéa AKG, Tramontt C, Cavagnari MAV, Novello D, Macedo DS. Clinical and nutritional characteristics on overall survival impact in patients with gastrointestinal cancer. Clin Nutr ESPEN 2022; 48: 336-341. https://doi.org/10.1016/j.clnesp.2022.01.021.
Chakaroun RM, Massier L, Kovacs P. Gut Microbiome. Intestinal permeability, and tissue bacteria in metabolic disease: perpetrators or bystanders? Nutrients. 2020 Apr 14;12(4):1082. https://doi: 10.3390/ nu12041082.
Jabłońska B, Mrowiec S. The role of immunonutrition in patients undergoing pancreaticoduodenectomy. Nutrients 2020; 12(9). https://doi.org/10.3390/nu12092547.
Cresci GAM, Lampe JW, Gibson G. Targeted approaches for in situ gut microbiome manipulation. J Parenter Enter Nutr 2020; 44(4): 581-588. https://doi.org/10.1002/jpen.1779.
Yamamoto J, Onodera H, Kaminaga Y, Kayaba Y, Usui M. Anamorelin lnduced acute hyperglycemia in a patient with advanced pancreatic cancer and diabetes: A Case Report. Tohoku J Exp Med 2024; 262(4): 263-268. https://doi.org/10.1620/tjem.2024. J013.
Liu F, Xiao Z, Zeng H, Li J, Ai F, Qi J. Early enteral nutrition with fructooligo- saccharides improves prognosis in severe acute pancreatitis. Sci Rep. 2025 Feb 12;15(1):5267. https://doi: 10.1038/s41598-025-89739-x.
Publicado
2025-03-06
Cómo citar
Wang, X., Wang, X., Zhang, Y., Wang, Z., Jiang, Y., & Ling, L. (2025). Effect of early enteral nutrition on postoperative outcomes in pancreatic cancer patients with diabetes.: Efecto de la nutrición enteral temprana en los resultados postoperatorios en pacientes con cáncer de páncreas y diabetes. Investigación Clínica, 66(1), 89-100. https://doi.org/10.54817/IC.v66n1a08
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