Abstract
BackgroundPatients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. Malnutrition increases surgical complications and reduces overall survival. Despite its severity, there are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery.MethodsParticipants received tailored nutritional counseling before and after surgery at 2 and 4 weeks after hospital discharge. Participants also recorded nutritional intake daily for 30 days, and these data were reviewed remotely by registered dietitians before nutritional counseling visits. Descriptive statistics were used to describe study outcomes.ResultsAll 26 patients approached to participate consented to the trial before HPB surgery. Seven were excluded after consent for failing to meet eligibility criteria (e.g., did not receive surgery). Nineteen participants (52.6% female, median age = 65 years) remained eligible for remote monitoring post-surgery. Nineteen used the mobile app food diary, 79% of participants recorded food intake for greater than 80% of study days, 95% met with the dietitian for all visits, and 89% were highly satisfied with the intervention. Among participants with complete data, the average percent caloric goal obtained was 82.4% (IQR: 21.7).ConclusionsThis intervention was feasible and acceptable to patients undergoing HPB surgery. Preliminary efficacy data showed most participants were able to meet calorie intake goals. Future studies should examine intervention efficacy in a larger, randomized controlled trial.Trial registrationClinicaltrials.gov. Registered 16 September 2019, https://clinicaltrials.gov/ct2/show/NCT04091165.
Highlights
Hepatopancreaticobiliary (HPB) surgeries have increased over the past two decades in the U.S [1,2,3]. Part of this growth has been driven by a rise in pancreatic, liver, and periampullary cancers, which are treated through HPB surgery [4,5,6]
In terms of preliminary efficacy, participants struggled meeting their daily caloric goals during the first week after surgery; most participants began achieving their caloric goals by week 2 and were able to maintain their caloric goals through weeks 3 and 4
Prior studies suggest that the transition from hospital to home after pancreatectomy and hepatectomy is challenging for many patients with cancer [33, 34, 42]
Summary
Hepatopancreaticobiliary (HPB) surgeries have increased over the past two decades in the U.S [1,2,3] Part of this growth has been driven by a rise in pancreatic, liver, and periampullary cancers, which are treated through HPB surgery [4,5,6]. Up to 40% of patients undergoing HPB surgery experience malnutrition 30 days after surgery [13,14,15,16]. There is a critical need to develop interventions that reduce malnutrition among patients undergoing HPB surgery. Patients undergoing hepatopancreatobiliary (HPB) surgery, such patients with pancreatic, periampullary, and liver cancer, are at high risk for malnutrition. There are limited interventions addressing malnutrition after HPB surgery. The aim of this pilot trial was to examine feasibility, acceptability, usability, and preliminary efficacy of a remote nutrition monitoring intervention after HPB surgery
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