{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T05:04:34Z","timestamp":1785042274374,"version":"3.55.0"},"reference-count":103,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,5,22]],"date-time":"2021-05-22T00:00:00Z","timestamp":1621641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Total pancreatectomy (TP) is a highly invasive procedure often performed in patients affected by anorexia, malabsorption, cachexia, and malnutrition, which are risk factors for bad surgical outcome and even may cause enhanced toxicity to chemo-radiotherapy. The role of nutritional therapies and the association between nutritional aspects and the outcome of patients who have undergone TP is described in some studies. The aim of this comprehensive review is to summarize the available recent evidence about the influence of nutritional factors in TP. Preoperative nutritional and metabolic assessment, but also intra-operative and post-operative nutritional therapies and their consequences, are analyzed in order to identify the aspects that can influence the outcome of patients undergoing TP. The results of this review show that preoperative nutritional status, sarcopenia, BMI and serum albumin are prognostic factors both in TP for pancreatic cancer to support chemotherapy, prevent recurrence and prolong survival, and in TP with islet auto-transplantation for chronic pancreatitis to improve postoperative glycemic control and obtain better outcomes. When it is possible, enteral nutrition is always preferable to parenteral nutrition, with the aim to prevent or reduce cachexia. Nowadays, the nutritional consequences of TP, including diabetes control, are improved and become more manageable.<\/jats:p>","DOI":"10.3390\/nu13061765","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T00:01:20Z","timestamp":1621814480000},"page":"1765","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Perioperative Nutritional Aspects in Total Pancreatectomy: A Comprehensive Review of the Literature"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7135-2666","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Furbetta","sequence":"first","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Comandatore","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6238-9176","authenticated-orcid":false,"given":"Desir\u00e9e","family":"Gianardi","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Palmeri","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2156-369X","authenticated-orcid":false,"given":"Gregorio","family":"Di Franco","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Guadagni","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Caprili","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Bianchini","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-5519","authenticated-orcid":false,"given":"Lorenzo Maria","family":"Fatucchi","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Picchi","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Bastiani","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Council of Research, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giandomenico","family":"Biancofiore","sequence":"additional","affiliation":[{"name":"Division of Transplant Anesthesia and Critical Care, University of Pisa, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Di Candio","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7742-9556","authenticated-orcid":false,"given":"Luca","family":"Morelli","sequence":"additional","affiliation":[{"name":"General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s13304-010-0005-z","article-title":"Total pancreatectomy: Indications, operative technique, and results: A single centre experience and review of literature","volume":"62","author":"Casadei","year":"2010","journal-title":"Updates Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1007\/s13304-016-0388-6","article-title":"Are there still indications for total pancreatectomy?","volume":"68","author":"Rangelova","year":"2016","journal-title":"Updates Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1016\/j.ejso.2019.11.514","article-title":"Pancreatic resections for metastases: A twenty-year experience from a tertiary care center","volume":"46","author":"Gianardi","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.suronc.2020.08.002","article-title":"Renal cell carcinoma: The role of radical surgery on different patterns of local or distant recurrence","volume":"35","author":"Palmeri","year":"2020","journal-title":"Surg. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s00520-008-0476-3","article-title":"Screening the nutritional status in oncology: A preliminary report on 1000 outpatients","volume":"17","author":"Bozzetti","year":"2009","journal-title":"Support. Care Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1111\/j.1365-2036.2005.02628.x","article-title":"Review article: Anorexia and cachexia in gastrointestinal cancer","volume":"22","author":"Ockenga","year":"2005","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_7","first-page":"277","article-title":"Role of nutrition in gastrointestinal oncological patients","volume":"14","author":"Moscatiello","year":"2010","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1097\/MPA.0000000000001137","article-title":"Exocrine pancreatic insufficiency and malnutrition in chronic pancreatitis: Identification, treatment, and consequences","volume":"47","author":"Min","year":"2018","journal-title":"Pancreas"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1177\/000313480507100604","article-title":"The effect of malnutrition on morbidity after Surgery for chronic pancreatitis","volume":"71","author":"Schnelldorfer","year":"2005","journal-title":"Am. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.clnu.2020.01.004","article-title":"ESPEN guideline on clinical nutrition in acute and chronic pancreatitis","volume":"39","author":"Arvanitakis","year":"2020","journal-title":"Clin. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1507\/endocrj.EJ14-0510","article-title":"Systematic review and meta-analysis of islet autotransplantation after total pancreatectomy in chronic pancreatitis patients","volume":"62","author":"Wu","year":"2015","journal-title":"Endocr. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1097\/00000658-199522240-00013","article-title":"Autologous islet transplantation to prevent diabetes after pancreatic resection","volume":"Volume 222","author":"Wahoff","year":"1995","journal-title":"Proceedings of the Annals of Surgery"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/01.TP.0000054618.03927.70","article-title":"Pancreatectomy with islet autotransplantation for the treatment of severe chronic pancreatitis: The first 40 patients at the Leicester General Hospital","volume":"76","author":"Clayton","year":"2003","journal-title":"Transplantation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"4122","DOI":"10.3748\/wjg.15.4122","article-title":"Relationship between perioperative glycemic control and postoperative infections","volume":"15","author":"Hanazaki","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_15","first-page":"190","article-title":"The pancreas: Causes for malabsorption","volume":"30","author":"Hackert","year":"2014","journal-title":"Visz. Gastrointest. Med. Surg."},{"key":"ref_16","first-page":"847","article-title":"Importance of nutritional management for the treatment of carcinoma of the pancreas","volume":"14","author":"Higashiguchi","year":"1988","journal-title":"Gan To Kagaku Ryoho"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"264","DOI":"10.7326\/0003-4819-151-4-200908180-00135","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"151","author":"Moher","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3748\/wjg.v23.i2.265","article-title":"Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy","volume":"23","author":"Shi","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2664","DOI":"10.1111\/ajt.12392","article-title":"Metabolic assessment prior to total pancreatectomy and islet autotransplant: Utility, limitations and potential","volume":"13","author":"Lundberg","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1007\/s11605-020-04687-3","article-title":"Pre-operative Sarcopenia Predicts Low Islet Cell Yield Following Total Pancreatectomy with Islet Autotransplantation for Chronic Pancreatitis","volume":"24","author":"Trikudanathan","year":"2020","journal-title":"J. Gastrointest. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"313","DOI":"10.3727\/096368910X514611","article-title":"Body mass index reflects islet isolation outcome in islet autotransplantation for patients with chronic pancreatitis","volume":"20","author":"Takita","year":"2011","journal-title":"Cell Transplant."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1007\/s13193-012-0189-4","article-title":"Nutritional Status and Nutritional Support Before and After Pancreatectomy for Pancreatic Cancer and Chronic Pancreatitis","volume":"3","author":"Karagianni","year":"2012","journal-title":"Indian J. Surg. Oncol."},{"key":"ref_23","first-page":"1","article-title":"Parenteral nutrition and insulin per protocol improve diabetes management after total pancreatectomy","volume":"65","author":"Andersen","year":"2018","journal-title":"Dan. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/j.pan.2017.06.010","article-title":"The impact of using an intraoperative goal directed fluid therapy protocol on clinical outcomes in patients undergoing total pancreatectomy and islet cell autotransplantation","volume":"17","author":"Wagar","year":"2017","journal-title":"Pancreatology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1002\/bjs.11296","article-title":"Systematic review of functional outcome and quality of life after total pancreatectomy","volume":"106","author":"Scholten","year":"2019","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1522","DOI":"10.1210\/jc.2017-02182","article-title":"Deficient Glucagon Response to Hypoglycemia during a Mixed Meal in Total Pancreatectomy\/Islet Autotransplantation Recipients","volume":"103","author":"Bogachus","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/MPA.0000000000000462","article-title":"Clinical characteristics and risk factors for the development of postoperative hepatic steatosis after total pancreatectomy","volume":"45","author":"Hata","year":"2016","journal-title":"Pancreas"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/1753-0407.12589","article-title":"Effect of intrapancreatic fat on diabetes outcomes after total pancreatectomy with islet autotransplantation","volume":"10","author":"Kizilgul","year":"2018","journal-title":"J. Diabetes"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1097\/MPA.0000000000001582","article-title":"Alterations in Enteroendocrine Hormones after Total Pancreatectomy with Islet Autotransplantation","volume":"49","author":"McEachron","year":"2020","journal-title":"Pancreas"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1002\/1097-0142(19810515)47:10<2375::AID-CNCR2820471009>3.0.CO;2-I","article-title":"The efficacy of nutritional assessment and support in cancer surgery","volume":"47","author":"Smale","year":"1981","journal-title":"Cancer"},{"key":"ref_31","first-page":"1001","article-title":"Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients","volume":"85","author":"Onodera","year":"1984","journal-title":"Nippon Geka Gakkai Zasshi."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1007\/s00595-011-0061-0","article-title":"The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma","volume":"42","author":"Nozoe","year":"2012","journal-title":"Surg. Today"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1097\/MPA.0000000000000336","article-title":"Outcomes of Systematic Nutritional Assessment and Medical Nutrition Therapy in Pancreatic Cancer","volume":"44","author":"Vashi","year":"2015","journal-title":"Pancreas"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/j.ejso.2015.07.022","article-title":"Prognostic nutritional index predicts survival and correlates with systemic inflammatory response in advanced pancreatic cancer","volume":"41","author":"Geng","year":"2015","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1002\/bjs.7305","article-title":"Nutritional predictors of postoperative outcome in pancreatic cancer","volume":"98","author":"Kanda","year":"2011","journal-title":"Br. J. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.surg.2009.02.001","article-title":"The correlation of nutrition risk index, nutrition risk score, and bioimpedance analysis with postoperative complications in patients undergoing gastrointestinal surgery","volume":"145","author":"Schiesser","year":"2009","journal-title":"Surgery"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"372","DOI":"10.14701\/ahbps.2019.23.4.372","article-title":"Clinical importance of preoperative and postoperative prognostic nutritional index in patients with pancreatic ductal adenocarcinoma","volume":"23","author":"Ikeguchi","year":"2019","journal-title":"Ann. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"168","DOI":"10.14701\/ahbps.2019.23.2.168","article-title":"Clinical significance of preoperative nutritional parameter and patient outcomes after pancreatectomy: A retrospective study at two academic institute","volume":"23","author":"Nanashima","year":"2019","journal-title":"Ann. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1097\/SLA.0000000000001453","article-title":"Factors predicting outcomes after a total pancreatectomy and islet autotransplantation lessons learned from over 500 cases","volume":"262","author":"Chinnakotla","year":"2015","journal-title":"Ann. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/j.jamcollsurg.2011.12.040","article-title":"Total pancreatectomy and islet autotransplantation for chronic pancreatitis","volume":"214","author":"Sutherland","year":"2012","journal-title":"J. Am. Coll. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1007\/s10620-012-2448-1","article-title":"MRI prediction of islet yield for autologous transplantation after total pancreatectomy for chronic pancreatitis","volume":"58","author":"Khan","year":"2013","journal-title":"Dig. Dis. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.cgh.2011.04.024","article-title":"Quality of Life Improves for Pediatric Patients After Total Pancreatectomy and Islet Autotransplant for Chronic Pancreatitis","volume":"9","author":"Bellin","year":"2011","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s40520-016-0709-0","article-title":"Nutrition, frailty, and sarcopenia","volume":"29","author":"Kiesswetter","year":"2017","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1017\/S0029665117001045","article-title":"Negotiating the complexities of exocrine and endocrine dysfunction in chronic pancreatitis","volume":"76","author":"Duggan","year":"2017","journal-title":"Proc. Nutr. Soc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1007\/s00268-020-05828-0","article-title":"Prevalence and Impact of Sarcopenia in Chronic Pancreatitis: A Review of the Literature","volume":"45","author":"Kuan","year":"2021","journal-title":"World J. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.surg.2016.11.014","article-title":"The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After","volume":"161","author":"Bassi","year":"2017","journal-title":"Surgery"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.pan.2019.01.006","article-title":"Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis","volume":"19","author":"Olesen","year":"2019","journal-title":"Pancreatology"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1002\/jso.23304","article-title":"Malnutrition and pancreatic surgery: Prevalence and outcomes","volume":"107","author":"Ziparo","year":"2013","journal-title":"J. Surg. Oncol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/j.1572-0241.2004.04005.x","article-title":"Factors associated with health-related quality of life in chronic pancreatitis","volume":"99","author":"Wehler","year":"2004","journal-title":"Am. J. Gastroenterol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"E602","DOI":"10.1111\/ans.14262","article-title":"Perioperative albumin ratio is associated with post-operative pancreatic fistula","volume":"88","author":"Gruppo","year":"2018","journal-title":"ANZ J. Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1007\/s11605-007-0223-y","article-title":"Association of hypoalbuminemia on the first postoperative day and complications following esophagectomy","volume":"11","author":"Ryan","year":"2007","journal-title":"J. Gastrointest. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.3748\/wjg.14.1248","article-title":"Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery","volume":"14","author":"Lohsiriwat","year":"2008","journal-title":"World J. Gastroenterol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1001\/archsurg.134.1.36","article-title":"Preoperative serum albumin level as a predictor of operative mortality and morbidity: Results from the National VA Surgical Risk Study","volume":"134","author":"Gibbs","year":"1999","journal-title":"Arch. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/S1091-255X(03)00067-2","article-title":"Outcome after pancreaticoduodenectomy for periampullary cancer: An analysis from the Veterans Affairs National Surgical Quality Improvement Program","volume":"Volume 7","author":"Billingsley","year":"2003","journal-title":"Proceedings of the Journal of Gastrointestinal Surgery"},{"key":"ref_55","first-page":"270","article-title":"Prognostic significance of the postoperative level and recovery rate of serum albumin in patients with curatively resected pancreatic ductal adenocarcinoma","volume":"11","author":"Nakano","year":"2019","journal-title":"Mol. Clin. Oncol."},{"key":"ref_56","first-page":"4493","article-title":"Cancer anorexia-cachexia syndrome: Are neuropeptides the key?","volume":"59","author":"Inui","year":"1999","journal-title":"Cancer Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/01.mco.0000134363.53782.cb","article-title":"Cancer anorexia-cachexia syndrome: Cytokines and neuropeptides","volume":"7","author":"Ramos","year":"2004","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1136\/gut.2004.047563","article-title":"Thalidomide in the treatment of cancer cachexia: A randomised placebo controlled trial","volume":"54","author":"Gordon","year":"2005","journal-title":"Gut"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/00000658-199410000-00003","article-title":"A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy","volume":"220","author":"Brennan","year":"1994","journal-title":"Ann. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1475-2891-2-18","article-title":"Nutrition support to patients undergoing gastrointestinal surgery","volume":"2","author":"Ward","year":"2003","journal-title":"Nutr. J."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.nut.2010.06.008","article-title":"Treatment with growth hormone, somatostatin, and insulin in combination with hypocaloric parenteral nutrition in gastrointestinal cancer patients after surgery","volume":"27","author":"Liu","year":"2011","journal-title":"Nutrition"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.gassur.2004.01.007","article-title":"Postoperative jejunal feeding and outcome of pancreaticoduodenectomy. In Proceedings of the Journal of Gastrointestinal Surgery","volume":"8","author":"Baradi","year":"2004","journal-title":"J. Gastrointest. Surg."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1097\/CCO.0b013e3283479c66","article-title":"Nutritional intervention for improving treatment tolerance in cancer patients","volume":"23","author":"Paccagnella","year":"2011","journal-title":"Curr. Opin. Oncol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/sj.bjc.6690654","article-title":"The effect of an oral nutritional supplement enriched with fish oil on weight-loss in patients with pancreatic cancer","volume":"81","author":"Barber","year":"1999","journal-title":"Br. J. Cancer"},{"key":"ref_65","first-page":"154","article-title":"Enteral nutrition is superior to total parenteral nutrition for pancreatic cancer patients who underwent pancreaticoduodenectomy","volume":"20","author":"Liu","year":"2011","journal-title":"Asia Pac. J. Clin. Nutr."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1097\/00003246-200102000-00003","article-title":"Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition","volume":"29","author":"Braga","year":"2001","journal-title":"Crit. Care Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1046\/j.1365-2168.1999.01033.x","article-title":"Dietary intake after pancreatectomy","volume":"86","author":"Maskell","year":"1999","journal-title":"Br. J. Surg."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.metabol.2010.08.006","article-title":"Continuous low-dose fructose infusion does not reverse glucagon-mediated decrease in hepatic glucose utilization","volume":"60","author":"Johnson","year":"2011","journal-title":"Metabolism"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.amjsurg.2007.10.030","article-title":"Is albumin administration beneficial in early stage of postoperative hypoalbuminemia following gastrointestinal surgery?: A prospective randomized controlled trial","volume":"196","author":"Yuan","year":"2008","journal-title":"Am. J. Surg."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1111\/hpb.12054","article-title":"Impact of total pancreatectomy: Short- and long-term assessment","volume":"15","author":"Barbier","year":"2013","journal-title":"HPB"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/hpb.12203","article-title":"How severe is diabetes after total pancreatectomy? A case-matched analysis","volume":"16","author":"Roberts","year":"2014","journal-title":"HPB"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1002\/(SICI)1096-9136(199702)14:2<99::AID-DIA320>3.0.CO;2-I","article-title":"Brittle diabetes revisited: The third Arnold Bloom memorial lecture","volume":"14","author":"Tattersall","year":"1997","journal-title":"Diabet. Med."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0889-8529(18)30386-4","article-title":"Regulation of carbohydrate metabolism and response to hypoglycemia","volume":"18","author":"Butler","year":"1989","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1097\/00000658-199108000-00007","article-title":"Metabolic consequences of (regional) total pancreatectomy","volume":"214","author":"Dresler","year":"1991","journal-title":"Ann. Surg."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2012\/381328","article-title":"Glycemic control after total pancreatectomy for intraductal papillary mucinous neoplasm: An exploratory study","volume":"2012","author":"Jamil","year":"2012","journal-title":"HPB Surg."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/j.dld.2006.01.022","article-title":"Diabetic control after total pancreatectomy","volume":"38","author":"Jethwa","year":"2006","journal-title":"Dig. Liver Dis."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2513","DOI":"10.1007\/s00268-016-3552-8","article-title":"A contemporary evaluation of the cause of death and long-term quality of life after total pancreatectomy","volume":"40","author":"Wu","year":"2016","journal-title":"World J. Surg."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"1880","DOI":"10.1111\/ajt.12776","article-title":"Defective glucagon secretion during hypoglycemia after intrahepatic but not nonhepatic islet autotransplantation","volume":"14","author":"Bellin","year":"2014","journal-title":"Am. J. Transplant."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/BF00282517","article-title":"Circulating glucagon after total pancreatectomy in man","volume":"25","author":"Holst","year":"1983","journal-title":"Diabetologia"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1007\/BF02469532","article-title":"Effects of total pancreatectomy on the secretion of gut glucagon in humans","volume":"13","author":"Yasui","year":"1983","journal-title":"Jpn. J. Surg."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"512","DOI":"10.2337\/diab.23.6.512","article-title":"Studies of glucagon secretion in pancreatectomized patients","volume":"23","author":"Muller","year":"1974","journal-title":"Diabetes"},{"key":"ref_82","first-page":"538","article-title":"Metabolic modulation by concomitant administration of insulin and glucagon in pancreatectomy patients","volume":"49","author":"Tanjoh","year":"2002","journal-title":"Hepatogastroenterology"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ecl.2012.11.001","article-title":"Novel approaches to studying the role of innervation in the biology of pancreatic islets. Endocrinol","volume":"42","author":"Caicedo","year":"2013","journal-title":"Metab. Clin. N. Am."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1210\/en.2011-2040","article-title":"Minireview: The role of the autonomic nervous system in mediating the glucagon response to hypoglycemia","volume":"153","author":"Taborsky","year":"2012","journal-title":"Endocrinology"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"4656","DOI":"10.1210\/jc.2004-0408","article-title":"Regulation of net hepatic glycogenolysis and gluconeogenesis during exercise: Impact of type 1 diabetes","volume":"89","author":"Petersen","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"3288","DOI":"10.1210\/jc.2017-00923","article-title":"Deficient endogenous glucose production during exercise after total pancreatectomy\/islet autotransplantation","volume":"102","author":"Bogachus","year":"2017","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1210\/jcem-63-2-439","article-title":"Total pancreatectomy increases the metabolic response to glucagon in humans","volume":"63","author":"Bajorunas","year":"1986","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.2337\/diabetes.54.4.1100","article-title":"The role of amylin and glucagon in the dampening of glycemic excursions in children with type 1 diabetes","volume":"54","author":"Heptulla","year":"2005","journal-title":"Diabetes"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s11605-006-0025-7","article-title":"Total pancreatectomy: Indications, operative technique, and postoperative sequelae","volume":"11","author":"Heidt","year":"2007","journal-title":"J. Gastrointest. Surg."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1080\/00365521.2016.1211173","article-title":"Clinicophysiological outcomes after total pancreatectomy","volume":"51","author":"Suzuki","year":"2016","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Robertson, R.P., Harmon, J., Tran, P.O.T., and Poitout, V. (2004). \u03b2-Cell Glucose Toxicity, Lipotoxicity, and Chronic Oxidative Stress in Type 2 Diabetes. Proceedings of the Diabetes, American Diabetes Association Inc.","DOI":"10.2337\/diabetes.53.2007.S119"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1080\/13651820701286177","article-title":"Hepato-pancreato-biliary fat: The good, the bad and the ugly","volume":"9","author":"Pitt","year":"2007","journal-title":"HPB"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1007\/s11892-010-0122-6","article-title":"The role of adipose tissue and lipotoxicity in the pathogenesis of type 2 diabetes","volume":"10","author":"Cusi","year":"2010","journal-title":"Curr. Diab. Rep."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1042\/CS20060115","article-title":"Life and death decisions of the pancreatic \u03b2-cell: The role of fatty acids","volume":"112","author":"Newsholme","year":"2007","journal-title":"Clin. Sci."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1097\/MPA.0b013e3181a9d5af","article-title":"Risk factors for hyperechogenic pancreas on endoscopic ultrasound: A case-control study","volume":"38","author":"Khashab","year":"2009","journal-title":"Pancreas"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/1475-2840-12-77","article-title":"Association between non-alcoholic fatty pancreatic disease (nafpd) and the metabolic syndrome: Case-control retrospective study","volume":"12","author":"Wu","year":"2013","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.coph.2013.09.012","article-title":"Enteroendocrine cells in gastrointestinal pathophysiology","volume":"13","author":"Harrison","year":"2013","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"23","DOI":"10.3389\/fnut.2015.00023","article-title":"The L-Cell in nutritional sensing and the regulation of appetite","volume":"2","author":"Spreckley","year":"2015","journal-title":"Front. Nutr."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.physbeh.2006.05.048","article-title":"Gastrointestinal satiety signals in humans\u2014Physiologic roles for GLP-1 and PYY ?","volume":"89","author":"Beglinger","year":"2006","journal-title":"Physiol. Behav."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1136\/gut.28.2.166","article-title":"Effects of peptide YY (PYY) on mouth to caecum intestinal transit time and on the rate of gastric emptying in healthy volunteers","volume":"28","author":"Savage","year":"1987","journal-title":"Gut"},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Nauck, M.A., Niedereichholz, U., Ettler, R., Holst, J.J., \u00d8rskov, C., Ritzel, R., and Schmiegel, W.H. (1997). Glucagon-like peptide 1 inhibition of gastric emptying outweighs its insulinotropic effects in healthy humans. Am. J. Physiol. Endocrinol. Metab., 273.","DOI":"10.1152\/ajpendo.1997.273.5.E981"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1152\/ajpgi.00536.2003","article-title":"Gastrointestinal Satiety Signals III. Glucagon-like peptide 1, oxyntomodulin, peptide YY, and pancreatic polypeptide","volume":"286","author":"Stanley","year":"2004","journal-title":"Am. J. Physiol. Gastrointest. Liver Physiol."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1111\/dom.12593","article-title":"Gastrointestinal actions of glucagon-like peptide-1-based therapies: Glycaemic control beyond the pancreas","volume":"18","author":"Smits","year":"2016","journal-title":"Diabetes Obes. Metab."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/6\/1765\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:05:57Z","timestamp":1760162757000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/13\/6\/1765"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,22]]},"references-count":103,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["nu13061765"],"URL":"https:\/\/doi.org\/10.3390\/nu13061765","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,22]]}}}