Studying the Post-Operatory and Molecular Modifications in the Chronic Pancreatitis and Pancreatic Cancer - The Importance of the Micronutrients and Pancreatic Enzyme Supplementation

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Abstract:

The pancreatic cancer is a disorder with an exponentially increased incidence, especially over the last few years. Moreover, it is estimated that almost 95% of the patients with this disease are presenting to the hospital in the advanced and unresectable stages. Also, over the past few decades the development and advance of the surgical methods and techniques have improved, with the most of the operatory actions in the chronic pancreatitis and pancreatic cancer being represented by the whipple duodeno-pancreatectomy, which in fact represents the standard resection for tumors of the duodenum, as well as the hepatopancreatic ampulla of Vater, distal choledocus and the head of the pancreas. Moreover, it is important to mention that in these cases, after an extended resection and reconstruction of the upper gastrointestinal tract, the digestive physiology will be disrupted. In addition, previous studies have shown that patients can maintain a body mass index after surgery but often this will be lower than its preoperative value. Thus, considering the aforementioned aspects, in the present mini-review we were mainly interested in presenting also the relevance of the micronutrients such as iron, selenium, vitamin D and E, zinc or copper in this complicated area of research, as well as aspects regarding the correlations between immune function and micronutrients or the pancreatic enzyme supplementation.

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[1] R. Pezzilli, Screening tests for pancreatic cancer: searching for the early symptoms or the population at risk, Jop. 5 (2004) 240-242.

Google Scholar

[2] E. Tamm, Diagnosis, staging, and surveillance of pancreatic cancer, AJR Am J Roentgenol. 180 (2003) 1311-1323.

Google Scholar

[3] W. Melvin, Outcome analysis of long-term survivors following pancreaticoduodenectomy, J Gastrointest Surg. 2 (1998) 72-78.

DOI: 10.1016/s1091-255x(98)80106-6

Google Scholar

[4] R. McLeod, Quality of life, nutritional status, and gastrointestinal hormone profile following the Whipple procedure, Am J Surg. 169 (1995) 179-185.

DOI: 10.1016/s0002-9610(99)80129-9

Google Scholar

[5] T. Armstrong, F. Ruiz-Jasbon, J. SheK, C. Permert, Pancreaticoduodenectomy for periampullary neoplasia leads to specific micronutrient deficiencies, Pancreatology. 7 (2007) 37-44.

DOI: 10.1159/000101876

Google Scholar

[6] B. Traş, F. Inal, A. Baş, V. Altunok, M. Elmas, E. Yazar, Effects of continuous supplementations of ascorbic acid, aspirin, vitamin E and selenium on some haematological parameters and serum superoxide dismutase level in broiler chickens, Br Poult Sci. 41 (2000) 664-666.

DOI: 10.1080/00071660020009225

Google Scholar

[7] R. Chandra, Effect of two feeding formulas on immune responses and mortality in mice challenged with Listeria monocytogenes, Immunol Lett. 27 (1991) 45-48.

DOI: 10.1016/0165-2478(91)90242-3

Google Scholar

[8] J. Kinsella, B. Lokesh, Dietary lipids, eicosanoids, and the immune system, Crit Care Med. 18 (1990) 94-113.

DOI: 10.1097/00003246-199002003-00003

Google Scholar

[9] S. Bengmark, R. Andersson, G. Mangiante, Uninterrupted perioperative enteral nutrition, Clin Nutr. 20 (2001) 11-19.

DOI: 10.1054/clnu.2000.0111

Google Scholar

[10] S. Cunningham-Rundles, D. Lin, Nutrition and the immune system of the gut, Nutrition. 14 (1998) 573-579.

DOI: 10.1016/s0899-9007(98)00029-x

Google Scholar

[11] M. Berger, Trace element supplementation modulates pulmonary infection rates after major burns: a double-blind, placebo-controlled trial, Am J Clin Nutr. 68 (1998) 365-371.

DOI: 10.1093/ajcn/68.2.365

Google Scholar

[12] C. Braunschweig, Parenteral zinc supplementation in adult humans during the acute phase response increases the febrile response, J Nutr. 127 (1997) 70-74.

DOI: 10.1093/jn/127.1.70

Google Scholar

[13] N. Leone, D. Courbon, P. Ducimetiere, M. Zureik, Zinc, copper, and magnesium and risks for all-cause, cancer, and cardiovascular mortality, Epidemiology. 17 (2006) 308-14.

DOI: 10.1097/01.ede.0000209454.41466.b7

Google Scholar

[14] D. Silverman, Risk factors for pancreatic cancer: a case-control study based on direct interviews, Teratog Carcinog Mutagen. 21 (2001) 7-25.

DOI: 10.1002/1520-6866(2001)21:1<7::aid-tcm3>3.0.co;2-a

Google Scholar

[15] R. Williamson, Gastric emptying and enterogastric reflux after conservative and conventional pancreatoduodenectomy, Surgery. 114 (1993) 82-86.

Google Scholar

[16] M. Muller, Gastric emptying following pylorus-preserving Whipple and duodenum-preserving pancreatic head resection in patients with chronic pancreatitis, Am J Surg. 173 (1997) 257-63.

DOI: 10.1016/s0002-9610(96)00402-3

Google Scholar

[17] P. Layer, Feedback regulation of human pancreatic secretion. Effects of protease inhibition on duodenal delivery and small intestinal transit of pancreatic enzymes, Gastroenterology. 98 (1990) 1311-1319.

DOI: 10.1016/0016-5085(90)90350-a

Google Scholar

[18] J. Dominguez-Munoz, Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study. Aliment Pharmacol Ther. 21 (2005) 993-1000.

DOI: 10.1111/j.1365-2036.2005.02390.x

Google Scholar