[Nutritional management in pancreatoduodenectomy patients]

Pancreatoduodenectomy is one of the most invasive and complex procedures in gastrointestinal surgery. Perioperative nutritional management, particularly enteral nutrition, is essential for patients undergoing pancreatoduodenectomy to attenuate postoperative complications and avoid progression of malnutrition due to surgical stress. Early enteral nutrition including immunonutrition via catheter jejunostomy is recommended from the viewpoint of protection from postoperative complications. If inadequate caloric administration via enteral nutrition alone cannot be achieved, combined enteral and parenteral nutrition is warranted. Postoperatively, feeding can potentially be started in the very early phase, similar to oral intake after gastrectomy. If adequate caloric administration cannot be achieved via enteral nutrition alone, combined enteral and parenteral nutrition is also warranted in the postoperative period. A fat-restricted diet is preferable if pancreatic exocrine function is disturbed due to accompanying or chronic pancreatitis and the deterioration of the remnant pancreatic preserve. Aggressive administration of commercially available pancreatic exocrine enzymes is recommended to prevent malabsorption of dietary lipids in the subacute and chronic stages after pancreatoduodenectomy. Oral supplementation of n-3 polyunsaturated fatty acids can be used in postoperative pancreatic cancer patients.