Nutrition Following Pancreatic Surgery

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Pancreatic cancer patients who undergo surgery for pancreatic cancer often have many questions and concerns about post-operative nutritional care.  Most importantly, patients and their caregivers should understand that each patient has individualized nutritional needs.  Consult with a registered dietitian or doctor before making any dietary changes.  The dietitian or doctor can also help create an appropriate dietary plan.

The table below provides basic short-term and long-term post-surgical nutritional guidelines for patients who have had pancreatic surgery. 

Short-term post-surgical nutritional guidelines:
  • If the patient has a jejunostomy tube (j-tube), feeding will initially be provided around-the-clock and will eventually be cycled to only nighttime. 
  • Start oral diet with clear liquids and advance to solid foods.
  • Eat small, frequent meals.
  • Avoid greasy and fried foods.
  • Limit consumption of raw fruits and vegetables, initially.  Gradually increase as tolerated.
Long-term post-surgical nutritional guidelines:
  • The patient may need to continue to avoid or limit fried, greasy and high-fat foods or eat them in smaller quantities.
  • Consume fat (as tolerated) from healthy sources such as olive oil, canola oil, peanut oil, nuts, seeds and avocados.
  • Aim for at least 2.5 cups of fruits and vegetables per day.
  • Take pancreatic enzymes if needed.
  • Take acid reducing medications as prescribed.
  • Engage in physical activity for at least 30 minutes per day.  Under the advice of the surgeon, weight training may be considered.

Because part of the pancreas is removed during surgery, the part that remains after surgery may not be able to produce enough enzymes to properly aid with the digestion of food, and patients may not be able to digest or absorb the fat from the food they eat. When undigested fat remains in the stool, it causes diarrhea and poor nutrition.  Patients may also experience bloating, excessive gas production and abdominal cramping.  Consequently, the goal for these patients is to eliminate or reduce diarrhea, restore adequate nutrition, prevent weight loss and manage bloating, cramping and gas. 

Patients who have had a Whipple surgery are more likely than those who have had a distal pancreatectomy (another type of pancreatic surgery) to have insufficient enzyme production. For more information about pancreatic enzymes, click here.

General recommendations following pancreatic surgery

  • Take the prescribed amount of pancreatic enzyme replacement products with all meals and snacks.
  • Gradually start adding solid foods.  The timing of this varies from individual to individual.
  • Avoid high-fat, greasy or fried foods.
  • Eat 6-8 small meals and snacks daily to prevent feeling overly full.  Small meals are easier to digest.  Space meals 2-3 hours apart.
  • Drink at least 6-12 cups of fluids each day.  Lack of fluids may lead to fatigue, light-headedness and nausea.
  • Take small sips of liquids with meals. Drinking too much fluid at mealtime may cause the patient to feel full quicker or increase nausea.  Drink liquids an hour before or after eating to avoid feeling full.
  • Drink beverages that contain calories, nutrients and protein, such as juices, smoothies or nutritional supplement drinks.  It is acceptable to drink small amounts of these at mealtimes or to use nutritional supplement drinks or protein smoothies as meal/snack replacements.
  • Avoid alcoholic beverages.
  • If the patient is nauseated and has an empty stomach, small bites of dry foods are often better tolerated than liquids.
  • Avoid eating concentrated refined/simple carbohydrates if symptoms of glucose intolerance or dumping are present.  Glucose intolerance symptoms include increased thirst, frequent urination, blurry vision and fatigue.  Dumping symptoms usually occur within 2 hours after eating and include flushed skin, dizziness/lightheadedness, weakness, abdominal pain, nausea, vomiting and diarrhea.
  • Discuss with your doctor or dietitian the use of a multivitamin or individual vitamin supplements.  Calcium and the fat-soluble vitamins A, D, E and K may be necessary if malabsorption-induced diarrhea is present.  Ask a healthcare professional for a proper dosage of individual vitamin supplements.
  • If anemia occurs, ask the doctor whether iron supplements or injections of vitamin B12 may be helpful. 
  • Keep a daily journal of the patient’s diet after surgery.  In addition to the foods and the amounts eaten, also record daily weight, amount of pancreatic enzymes used, frequency and consistency of bowel movements, and blood glucose readings (if applicable).  This information can be useful in tracking nutritional progress and can help the doctor or dietitian make further recommendations.

For more information about pancreatic cancer, please contact a Patient and Liaison Services (PALS) Associate toll-free at 877-272-6226 or email pals@pancan.org.  PALS Associates are available M-F 7am-5pm Pacific Time.

 

 

Information provided by the Pancreatic Cancer Action Network, Inc. (“PanCAN”) is not a substitute for medical advice, diagnosis, treatment or other health care services. PanCAN may provide information to you about physicians, products, services, clinical trials or treatments related to pancreatic cancer, but PanCAN does not recommend nor endorse any particular health care resource. In addition, please note that any personal information you provide to PanCAN’s associates during telephone and/or email communications may be stored and used to help PanCAN achieve its mission of assisting patients with, and finding cures and treatments for, pancreatic cancer. Stored constituent information may be used to inform PanCAN programs and activities. Information also may be provided in aggregate or limited formats to third parties to guide future pancreatic cancer research and treatment efforts. PanCAN will not provide personal directly identifying information (such as your name or contact information) to such third parties without your prior written consent unless required or permitted by law to do so.