{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T21:47:30Z","timestamp":1788558450072,"version":"build-2803163510"},"reference-count":74,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2017,3,7]],"date-time":"2017-03-07T00:00:00Z","timestamp":1488844800000},"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>Pancreatic cancer is an aggressive malignancy with a poor prognosis. The disease and its treatment can cause significant nutritional impairments that often adversely impact patient quality of life (QOL). The pancreas has both exocrine and endocrine functions and, in the setting of cancer, both systems may be affected. Pancreatic exocrine insufficiency (PEI) manifests as weight loss and steatorrhea, while endocrine insufficiency may result in diabetes mellitus. Surgical resection, a central component of pancreatic cancer treatment, may induce or exacerbate these dysfunctions. Nutritional and metabolic dysfunctions in patients with pancreatic cancer lack characterization, and few guidelines exist for nutritional support in patients after surgical resection. We reviewed publications from the past two decades (1995\u20132016) addressing the nutritional and metabolic status of patients with pancreatic cancer, grouping them into status at the time of diagnosis, status at the time of resection, and status of nutritional support throughout the diagnosis and treatment of pancreatic cancer. Here, we summarize the results of these investigations and evaluate the effectiveness of various types of nutritional support in patients after pancreatectomy for pancreatic adenocarcinoma (PDAC). We outline the following conservative perioperative strategies to optimize patient outcomes and guide the care of these patients: (1) patients with albumin &lt; 2.5 mg\/dL or weight loss &gt; 10% should postpone surgery and begin aggressive nutrition supplementation; (2) patients with albumin &lt; 3 mg\/dL or weight loss between 5% and 10% should have nutrition supplementation prior to surgery; (3) enteral nutrition (EN) should be preferred as a nutritional intervention over total parenteral nutrition (TPN) postoperatively; and, (4) a multidisciplinary approach should be used to allow for early detection of symptoms of endocrine and exocrine pancreatic insufficiency alongside implementation of appropriate treatment to improve the patient\u2019s quality of life.<\/jats:p>","DOI":"10.3390\/nu9030243","type":"journal-article","created":{"date-parts":[[2017,3,7]],"date-time":"2017-03-07T11:12:32Z","timestamp":1488885152000},"page":"243","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":195,"title":["Nutritional and Metabolic Derangements in Pancreatic Cancer and Pancreatic Resection"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0116-0412","authenticated-orcid":false,"given":"Taylor","family":"Gilliland","sequence":"first","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Villafane-Ferriol","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Shah","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Shah","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8612-8272","authenticated-orcid":false,"given":"Hop","family":"Tran Cao","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7891-4134","authenticated-orcid":false,"given":"Nader","family":"Massarweh","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Silberfein","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"Choi","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cary","family":"Hsu","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"McElhany","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Barakat","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Fisher","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7637-3717","authenticated-orcid":false,"suffix":"II","given":"George","family":"Van Buren","sequence":"additional","affiliation":[{"name":"The Elkins Pancreas Center, Michael E. DeBakey Department of Surgery, and Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,3,7]]},"reference":[{"key":"ref_1","unstructured":"American Cancer Society: Cancer Facts & Figures 2016. Available online: http:\/\/www.cancer.org\/content\/dam\/cancer-org\/research\/cancer-facts-and-statistics\/annual-cancer-facts-and-figures\/2016\/cancer-facts-and-figures-2016.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2913","DOI":"10.1158\/0008-5472.CAN-14-0155","article-title":"Projecting cancer incidence and deaths to 2030: The unexpected burden of thyroid, liver, and pancreas cancers in the united states","volume":"74","author":"Rahib","year":"2014","journal-title":"Cancer Res."},{"key":"ref_3","unstructured":"Costanzo, L.S. (2014). BRS Physiology. Physiology."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s00520-012-1514-8","article-title":"Symptoms in advanced pancreatic cancer are of importance for energy intake","volume":"21","author":"Bye","year":"2013","journal-title":"Support. Care Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.clnu.2003.07.001","article-title":"Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer","volume":"23","author":"Davidson","year":"2004","journal-title":"Clin. Nutr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1007\/s00520-010-1011-x","article-title":"Nutritional status of patients with locally advanced pancreatic cancer: A pilot study","volume":"19","author":"Ferrucci","year":"2011","journal-title":"Support. Care Cancer"},{"key":"ref_7","first-page":"2111","article-title":"Parenteral nutrition support for patients with pancreatic cancer\u2014Improvement of the nutritional status and the therapeutic outcome","volume":"32","author":"Richter","year":"2012","journal-title":"Anticancer Res."},{"key":"ref_8","first-page":"195","article-title":"Nutrition in Pancreatic Cancer: A Review","volume":"2","author":"Aghdassi","year":"2016","journal-title":"Gastrointest. Tumors"},{"key":"ref_9","first-page":"9361","article-title":"Cachexia and pancreatic cancer: Are there treatment options?","volume":"20","author":"Mueller","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1477-2574.2010.00178.x","article-title":"Cachexia in pancreatic cancer: New treatment options and measures of success","volume":"12","author":"Fearon","year":"2010","journal-title":"HPB"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.clnu.2004.08.012","article-title":"Increased length of hospital stay in underweight and overweight patients at hospital admission: A controlled population study","volume":"24","author":"Kyle","year":"2005","journal-title":"Clin. Nutr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1007\/s11605-008-0505-z","article-title":"Cachexia worsens prognosis in patients with resectable pancreatic cancer","volume":"12","author":"Bachmann","year":"2008","journal-title":"J. Gastrointest. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e43","DOI":"10.1097\/MCG.0b013e31829f56e7","article-title":"A prospective assessment of the natural course of the exocrine pancreatic function in patients with a pancreatic head tumor","volume":"48","author":"Sikkens","year":"2014","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.pan.2015.12.005","article-title":"New-onset type 2 diabetes mellitus\u2014A high-risk group suitable for the screening of pancreatic cancer?","volume":"16","author":"Terzin","year":"2016","journal-title":"Pancreatology"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Roeyen, G., Jansen, M., Chapelle, T., Bracke, B., Hartman, V., Ysebaert, D., and De Block, C. (2016). Diabetes mellitus and pre-diabetes are frequently undiagnosed and underreported in patients referred for pancreatic surgery. A prospective observational study. Pancreatology.","DOI":"10.1016\/j.hpb.2016.01.410"},{"key":"ref_16","first-page":"103","article-title":"Weight Loss, Diabetes, Fatigue, and Depression Preceding Pancreatic Cancer","volume":"7","author":"Olson","year":"2015","journal-title":"Pancreas"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1016\/j.cgh.2006.06.024","article-title":"New-Onset Diabetes and Pancreatic Cancer","volume":"4","author":"Gupta","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_18","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_19","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1053\/j.gastro.2008.01.039","article-title":"Prevalence and Clinical Profile of Pancreatic Cancer-Associated Diabetes Mellitus","volume":"134","author":"Pannala","year":"2008","journal-title":"Gastroenterology"},{"key":"ref_20","first-page":"365","article-title":"Unintentional weight loss is the most important indicator of malnutrition among surgical cancer patients","volume":"70","author":"Loh","year":"2012","journal-title":"Neth J. Med."},{"key":"ref_21","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":"7","author":"Billingsley","year":"2003","journal-title":"J. Gastrointest. Surg."},{"key":"ref_22","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","volume":"134","author":"Gibbs","year":"1999","journal-title":"Arch. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.surg.2016.07.010","article-title":"Frailty predicts risk of life-threatening complications and mortality after pancreatic resections","volume":"160","author":"Augustin","year":"2016","journal-title":"Surgery"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1097\/MPA.0000000000000446","article-title":"Evaluation of Modified Glasgow Prognostic Score for Pancreatic Cancer: A Retrospective Cohort Study","volume":"45","author":"Imaoka","year":"2016","journal-title":"Pancreas"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1007\/s11605-013-2417-9","article-title":"Trends and Risk Factors for Transfusion in Hepatopancreatobiliary Surgery","volume":"18","author":"Lucas","year":"2014","journal-title":"J. Gastrointest. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.pan.2015.02.006","article-title":"Pancreatic polypeptide response to a mixed meal is blunted in pancreatic head cancer associated with diabetes mellitus","volume":"15","author":"Hart","year":"2015","journal-title":"Pancreatology"},{"key":"ref_27","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_28","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1007\/s11605-012-1927-1","article-title":"The Daily Practice of Pancreatic Enzyme Replacement Therapy After Pancreatic Surgery: A Northern European Survey: Enzyme Replacement After Surgery","volume":"16","author":"Sikkens","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.ciresp.2009.03.014","article-title":"Pancreatic and periampullary tumours: Morbidity, mortality, functional results, and long-term survival","volume":"86","author":"Sabater","year":"2009","journal-title":"Cirug\u00eda Espa\u00f1ola"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1002\/bjs.9146","article-title":"Effects of pancreatectomy on nutritional state, pancreatic function and quality of life","volume":"100","author":"Park","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/bjs.9342","article-title":"Prospective assessment of the influence of pancreatic cancer resection on exocrine pancreatic function","volume":"101","author":"Sikkens","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Kang, J.S., Jang, J.Y., Kang, M.J., Kim, E., Jung, W., Chang, J., Shin, Y., Youngmin, H., and Kim, S.W. (2015). Endocrine Function Impairment after Distal Pancreatectomy: Incidence and Related Factors. World J. Surg.","DOI":"10.1007\/s00268-015-3228-9"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.pan.2016.01.006","article-title":"Metabolic effect of pancreatoduodenectomy: Resolution of diabetes mellitus after surgery","volume":"16","author":"Kang","year":"2016","journal-title":"Pancreatology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2110","DOI":"10.1007\/s00268-011-1170-z","article-title":"Zinc deficiency in patients undergoing pancreatoduodenectomy for periampullary tumors is associated with pancreatic exocrine insufficiency","volume":"35","author":"Yu","year":"2011","journal-title":"World J. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1548","DOI":"10.1007\/s11605-008-0560-5","article-title":"Distal pancreatectomy: Incidence of postoperative diabetes","volume":"12","author":"King","year":"2008","journal-title":"J. Gastrointest. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1007\/s11605-012-2039-7","article-title":"Pancreatic Volumetric Assessment as a Predictor of New-Onset Diabetes Following Distal Pancreatectomy","volume":"16","author":"Shirakawa","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1111\/j.1445-2197.2012.06080.x","article-title":"Long-term effects of pancreaticoduodenectomy on glucose metabolism","volume":"82","author":"You","year":"2012","journal-title":"ANZ J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/j.1477-2574.2012.00520.x","article-title":"Immediate post-resection diabetes mellitus after pancreaticoduodenectomy: Incidence and risk factors","volume":"15","author":"Ferrara","year":"2013","journal-title":"HPB"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s11605-014-2521-5","article-title":"Predictive Factors for Change of Diabetes Mellitus Status After Pancreatectomy in Preoperative Diabetic and Nondiabetic Patients","volume":"18","author":"Hirata","year":"2014","journal-title":"J. Gastrointest. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/s11605-014-2669-z","article-title":"Incidence and Severity of Pancreatogenic Diabetes After Pancreatic Resection","volume":"19","author":"Burkhart","year":"2015","journal-title":"J. Gastrointest. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1109","DOI":"10.1097\/MD.0000000000001109","article-title":"Glycemic Change After Pancreaticoduodenectomy: A Population-Based Study","volume":"94","author":"Wu","year":"2015","journal-title":"Medicine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.jamcollsurg.2005.03.026","article-title":"Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for longterm outcomes of pancreatic exocrine function","volume":"201","author":"Rault","year":"2005","journal-title":"J. Am. Coll. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1007\/s11605-011-1805-2","article-title":"Late complications after pancreaticoduodenectomy with pancreaticogastrostomy","volume":"16","author":"Bock","year":"2012","journal-title":"J. Gastrointest. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000101876","article-title":"Pancreaticoduodenectomy for peri-ampullary neoplasia leads to specific micronutrient deficiencies","volume":"7","author":"Armstrong","year":"2007","journal-title":"Pancreatology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2337\/diabetes.52.1.102","article-title":"Beta-cell deficit and increased beta-Cell apoptosis in humans with type 2 diabetes","volume":"52","author":"Butler","year":"2003","journal-title":"Diabetes"},{"key":"ref_46","first-page":"5","article-title":"Systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy","volume":"7","author":"Goonetilleke","year":"2006","journal-title":"JOP"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.clnu.2010.10.001","article-title":"The immunomodulating enteral nutrition in malnourished surgical patients\u2014A prospective, randomized, double-blind clinical trial","volume":"30","author":"Klek","year":"2011","journal-title":"Clin. Nutr."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1007\/s11605-014-2581-6","article-title":"Feeding Jejunostomy Tube Placement in Patients Undergoing Pancreaticoduodenectomy: An Ongoing Dilemma","volume":"18","author":"Nussbaum","year":"2014","journal-title":"J. Gastrointest. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1111\/hpb.12197","article-title":"Early oral feeding after pancreatoduodenectomy enhances recovery without increasing morbidity","volume":"16","author":"Gerritsen","year":"2014","journal-title":"HPB"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/1475-2891-8-24","article-title":"Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: A pilot study","volume":"8","author":"Nagata","year":"2009","journal-title":"Nutr. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/00075197-200001000-00004","article-title":"Nutritional and metabolic aspects of pancreatic cancer","volume":"3","author":"Cooperman","year":"2000","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"261","DOI":"10.3346\/jkms.2012.27.3.261","article-title":"Postoperative Nutritional Effects of Early Enteral Feeding Compared with Total Parental Nutrition in Pancreaticoduodectomy Patients: A Prosepective, Randomized Study","volume":"27","author":"Park","year":"2012","journal-title":"J. Korean Med. Sci."},{"key":"ref_53","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_54","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1097\/00000658-199504000-00002","article-title":"Enteral Nutrition During Multimodality Therapy in Upper Gastrointestinal Cancer Patients","volume":"221","author":"Daly","year":"1995","journal-title":"Ann. Surg."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1097\/00000658-199603000-00013","article-title":"Early Enteral Feeding in Postsurgical Cancer Patients: Fish Oil Structed Lipid-Based Polymer Formula vs. Standard Polymerase Formula","volume":"223","author":"Kenlar","year":"1996","journal-title":"Ann Surg."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Pelzer, U., Arnold, D., Goevercin, M., Stieler, J., Doerken, B., Riess, H., and Oettle, H. (2010). Parenteral nutrition support for patients with pancreatic cancer. Results of a phase II study. BMC Cancer, 10.","DOI":"10.1186\/1471-2407-10-86"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Vashi, P.G., Dahlk, S., Popiel, B., Lammersfeld, C.A., Ireton-Jones, C., and Gupta, D. (2014). A longitudinal study investigating quality of life and nutritional outcomes in advanced cancer patients receiving home parenteral nutrition. BMC Cancer, 14.","DOI":"10.1186\/1471-2407-14-593"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1207\/S15327914NC3602_6","article-title":"Effect of Oral Eicosapentaenoic Acid on Weight Loss in Patients With Pancreatic Cancer","volume":"36","author":"Wigmore","year":"2000","journal-title":"Nutr. Cancer"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1207\/S15327914NC402_7","article-title":"Effect of a Fish Oil-Enriched Nutritional Supplement on Metabolic Mediators in Patients With Pancreatic Cancer Cachexia","volume":"40","author":"Barber","year":"2001","journal-title":"Nutr. Cancer"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1002\/ijc.20291","article-title":"Omega-3 fatty acids improve liver and pancreas function in postoperative cancer patients","volume":"111","author":"Heller","year":"2004","journal-title":"Int. J. Cancer"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1097\/SLA.0000000000001896","article-title":"Early Enteral Versus Total Parenteral Nutrition in Patients Undergoing Pancreaticoduodenectomy: A Randomized Multicenter Controlled Trial (Nutri-DPC)","volume":"264","author":"Perinel","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1042\/cs0980389","article-title":"Metabolic response to feeding in weight-losing pancreatic cancer patients and its modulation by a fish-oil-enriched nutritional supplement","volume":"98","author":"Barber","year":"2000","journal-title":"Clin. Sci."},{"key":"ref_63","first-page":"190","article-title":"The pancreas: Causes for malabsorption","volume":"30","author":"Hackert","year":"2014","journal-title":"Visz. Gastrointest. Med. Surg."},{"key":"ref_64","unstructured":"BAPEN \u201cMalnutrition Universal Screening Tool\u201d MAG the 5 \u201cMUST\u201d Steps e c Sc or Sc or Sc. Available online: http:\/\/www.bapen.org.uk\/screening-and-must\/must-calculator."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.pan.2015.07.001","article-title":"Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use","volume":"15","author":"Lindkvist","year":"2015","journal-title":"Pancreatology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1002\/pdi.2006","article-title":"Pancreatitis, pancreatic cancer, and diabetes","volume":"33","author":"Hillson","year":"2016","journal-title":"Pract. Diabetes"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1053\/j.gastro.2007.03.050","article-title":"The Role of Obesity and Related Metabolic Disturbances in Cancers of the Colon, Prostate, and Pancreas","volume":"132","author":"Giovannucci","year":"2007","journal-title":"Gastroenterology"},{"key":"ref_68","first-page":"392","article-title":"Metabolic disorders in patients operated for pancreatic cancer","volume":"118","author":"Timofte","year":"2014","journal-title":"Rev. Med. Chir. Soc. Med. Nat. Iasi"},{"key":"ref_69","first-page":"789","article-title":"Postoperative care following pancreatic surgery: Surveillance and treatment","volume":"106","author":"Keim","year":"2009","journal-title":"Dtsch. Arzteblatt Int."},{"key":"ref_70","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_71","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/MPA.0b013e3182319d7c","article-title":"Different incretin responses after pancreatoduodenectomy and distal pancreatectomy","volume":"41","author":"Mori","year":"2012","journal-title":"Pancreas"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1017\/S000711450000074X","article-title":"Protein-energy undernutrition in hospital in-patients","volume":"83","author":"Corish","year":"2000","journal-title":"Br. J. 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