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Article ; Online: Reply to: Is it time to optimize immunonutrition in cancer patients according to muscle mass?

Gianotti, Luca

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2023 Volume 49, Issue 7, Page(s) 1324–1325

MeSH term(s)	Humans ; Immunonutrition Diet ; Postoperative Complications ; Surgical Wound Infection ; Neoplasms/therapy ; Muscles
Language	English
Publishing date	2023-04-29
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2023.04.012
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Article ; Online: Modelling centralization of pancreatic surgery: some additional considerations.

Gianotti, Luca

The British journal of surgery

2020 Volume 107, Issue 13, Page(s) e670

MeSH term(s)	Hospitals, Low-Volume ; Humans ; Pancreatectomy
Language	English
Publishing date	2020-10-13
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.12057
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Article ; Online: Evaluation and management of body composition changes in cancer patients.

Wang, Junjie / Tan, Shanjun / Gianotti, Luca / Wu, Guohao

Nutrition (Burbank, Los Angeles County, Calif.)

2023 Volume 114, Page(s) 112132

Abstract: Wasting in cancer patients has long been recognized as a condition that adversely affects cancer patients' quality of life, treatment tolerance, and oncological outcomes. Historically, this condition was mainly evaluated by changes in body weight. ... ...

Abstract	Wasting in cancer patients has long been recognized as a condition that adversely affects cancer patients' quality of life, treatment tolerance, and oncological outcomes. Historically, this condition was mainly evaluated by changes in body weight. However, this approach is not quite accurate because body weight is the overall change of all body compartments. Conditions such as edema and ascites can mask the severity of muscle and adipose tissue depletion. Changes in body composition assessment in cancer patients have historically been underappreciated because of the limited availability of measurement tools. As more evidence highlighting the importance of body composition has emerged, it is imperative to apply a more precise evaluation of nutritional status and a more targeted approach to provide nutritional support for cancer patients. In this review, we will discuss the modalities for evaluating body composition and how to manage body composition changes in cancer patients.
MeSH term(s)	Humans ; Quality of Life ; Neoplasms/complications ; Neoplasms/therapy ; Neoplasms/pathology ; Cachexia/etiology ; Cachexia/therapy ; Cachexia/pathology ; Body Composition ; Body Weight ; Sarcopenia/complications ; Muscle, Skeletal/pathology
Language	English
Publishing date	2023-06-14
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, Non-U.S. Gov't
ZDB-ID	639259-3
ISSN	1873-1244 ; 0899-9007
ISSN (online)	1873-1244
ISSN	0899-9007
DOI	10.1016/j.nut.2023.112132
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Article ; Online: Evaluation and management of body composition changes in cancer patients

Wang, Junjie / Tan, Shanjun / Gianotti, Luca / Wu, Guohao

Nutrition. 2023 Oct., v. 114 p.112132-

2023

Abstract: Wasting in cancer patients has long been recognized as a condition that adversely affects cancer patients’ quality of life, treatment tolerance, and oncological outcomes. Historically, this condition was mainly evaluated by changes in body weight. ... ...

Abstract	Wasting in cancer patients has long been recognized as a condition that adversely affects cancer patients’ quality of life, treatment tolerance, and oncological outcomes. Historically, this condition was mainly evaluated by changes in body weight. However, this approach is not quite accurate because body weight is the overall change of all body compartments. Conditions such as edema and ascites can mask the severity of muscle and adipose tissue depletion. Changes in body composition assessment in cancer patients have historically been underappreciated because of the limited availability of measurement tools. As more evidence highlighting the importance of body composition has emerged, it is imperative to apply a more precise evaluation of nutritional status and a more targeted approach to provide nutritional support for cancer patients. In this review, we will discuss the modalities for evaluating body composition and how to manage body composition changes in cancer patients.
Keywords	adipose tissue ; ascites ; body composition ; body weight ; edema ; muscles ; nutritional status ; nutritional support ; quality of life ; Cancer ; Skeletal muscle ; sarcopenia ; Cachexia
Language	English
Dates of publication	2023-10
Publishing place	Elsevier Inc.
Document type	Article ; Online
ZDB-ID	639259-3
ISSN	1873-1244 ; 0899-9007
ISSN (online)	1873-1244
ISSN	0899-9007
DOI	10.1016/j.nut.2023.112132
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Article ; Online: Pharmaconutrition: Which substrates?

Gianotti, Luca / Nespoli, Luca / Sandini, Marta

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2022 Volume 50, Issue 5, Page(s) 106798

Abstract: With the term "pharmaconutrition" or "immunonutrition" is intended the use of specific nutritional substrates having the ability of modulating specific mechanisms involved in several immune and inflammatory pathways. To achieve these goals, these ... ...

Abstract	With the term "pharmaconutrition" or "immunonutrition" is intended the use of specific nutritional substrates having the ability of modulating specific mechanisms involved in several immune and inflammatory pathways. To achieve these goals, these substrates have to be administered with over physiologic dose. Glutamine and omega-3 polyunsaturated fatty acids, used as single substrate, did not show clear clinical advantages on solid endpoints such as postoperative complications. Despite several multiple substrate enteral feeds are available on the market, very few of them have been tested in randomized clinical trial to prove efficacy. The most extensive investigated formulation is a combination of arginine, omega-3 fatty acids, ribonucleic acid with or without glutamine. Several meta-analyses of randomized clinical trials have been conducted to compare the effects of enteral immunonutrition with control diets on post-surgical morbidity. The results consistently showed that the use of enteral multiple substrate formulas significantly reduced infectious complications and duration of hospitalization. In a more contemporary view, pharmaconutrition should be tested more accurately in the contest of enhanced recovery programs, during neoadjuvant chemotherapy, and in the prehabilitation setting.
MeSH term(s)	Humans ; Enteral Nutrition/methods ; Glutamine/administration & dosage ; Fatty Acids, Omega-3/administration & dosage ; Arginine/administration & dosage ; Postoperative Complications/prevention & control
Chemical Substances	Glutamine (0RH81L854J) ; Fatty Acids, Omega-3 ; Arginine (94ZLA3W45F)
Language	English
Publishing date	2022-12-11
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2022.12.003
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Article: Cross-sectional imaging after pancreatic surgery: The dialogue between the radiologist and the surgeon.

Maino, Cesare / Cereda, Marco / Franco, Paolo Niccolò / Boraschi, Piero / Cannella, Roberto / Gianotti, Luca Vittorio / Zamboni, Giulia / Vernuccio, Federica / Ippolito, Davide

European journal of radiology open

2024 Volume 12, Page(s) 100544

Abstract: Pancreatic surgery is nowadays considered one of the most complex surgical approaches and not unscathed from complications. After the surgical procedure, cross-sectional imaging is considered the non-invasive reference standard to detect early and late ... ...

Abstract	Pancreatic surgery is nowadays considered one of the most complex surgical approaches and not unscathed from complications. After the surgical procedure, cross-sectional imaging is considered the non-invasive reference standard to detect early and late compilations, and consequently to address patients to the best management possible. Contras-enhanced computed tomography (CECT) should be considered the most important and useful imaging technique to evaluate the surgical site. Thanks to its speed, contrast, and spatial resolution, it can help reach the final diagnosis with high accuracy. On the other hand, magnetic resonance imaging (MRI) should be considered as a second-line imaging approach, especially for the evaluation of biliary findings and late complications. In both cases, the radiologist should be aware of protocols and what to look at, to create a robust dialogue with the surgeon and outline a fitted treatment for each patient.
Language	English
Publishing date	2024-01-19
Publishing country	England
Document type	Journal Article
ZDB-ID	2810314-2
ISSN	2352-0477
ISSN	2352-0477
DOI	10.1016/j.ejro.2023.100544
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Article ; Online: The 2019 ESPEN Arvid Wretlind lecture perioperative nutritional and metabolic care: Patient-tailored or organ-specific approach?

Gianotti, Luca / Sandini, Marta

Clinical nutrition (Edinburgh, Scotland)

2019 Volume 39, Issue 8, Page(s) 2347–2357

Abstract: Background & aim: The perioperative severe changes in the nutritional and metabolic homeostasis are, by some means, proportional to the extent of tissue injury and magnitude of operative trauma. An adequate qualitative and quantitative replacement of ... ...

Abstract	Background & aim: The perioperative severe changes in the nutritional and metabolic homeostasis are, by some means, proportional to the extent of tissue injury and magnitude of operative trauma. An adequate qualitative and quantitative replacement of nutritional substrates are of utmost importance to facilitate proper tissue healing and recovery and maintenance of organ function after surgery. Methods: The present manuscript has been planned to put the most recent research of the Milano-Bicocca University surgical working group in the context of a more personalized nutritional therapy and metabolic care for surgical patients. Particular prominence has been given to major pancreatic resections because these surgeries are among the most complex and challenging operations for the degree of parenchyma resection and tissue dissection, the consequent overall injury, and the fairly high rate of major complications resulting in a catabolic response. Results: Anthropometric parameters and particularly sarcopenia, visceral obesity - and their relative proportion -, are strongly associated with poor outcome after pancreatic surgery. Adequate perioperative nutritional therapy is of utmost importance in affecting morbidity. Long-term nutritional and metabolic sequelae, caused by exocrine pancreatic insufficiency, need to be promptly recognized and treated with an adequate enzyme supplementation. Conclusions: There is strong evidence sustaining the necessity of proper perioperative metabolic and nutritional care into the management of patients undergoing major pancreatic surgery.
MeSH term(s)	Adult ; Digestive System Surgical Procedures/adverse effects ; Female ; Humans ; Male ; Malnutrition/etiology ; Malnutrition/prevention & control ; Middle Aged ; Nutrition Therapy/methods ; Nutritional Status ; Pancreas/surgery ; Perioperative Care/methods ; Postoperative Complications/etiology ; Postoperative Complications/prevention & control ; Precision Medicine/methods ; Sarcopenia/etiology ; Sarcopenia/prevention & control
Language	English
Publishing date	2019-11-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2019.10.029
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Article ; Online: Reply to: Re: Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS).

Gianotti, Luca / Sandini, Marta

Surgery

2019 Volume 165, Issue 6, Page(s) 1249

MeSH term(s)	Humans ; Nutritional Support ; Pancreatic Fistula ; Pancreaticoduodenectomy
Language	English
Publishing date	2019-03-08
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2019.01.022
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Article: The 2019 ESPEN Arvid Wretlind lecture perioperative nutritional and metabolic care: Patient-tailored or organ-specific approach?

Gianotti, Luca / Sandini, Marta

Clinical nutrition. 2019 Oct. 25,

2019

Abstract: The perioperative severe changes in the nutritional and metabolic homeostasis are, by some means, proportional to the extent of tissue injury and magnitude of operative trauma. An adequate qualitative and quantitative replacement of nutritional ... ...

Abstract	The perioperative severe changes in the nutritional and metabolic homeostasis are, by some means, proportional to the extent of tissue injury and magnitude of operative trauma. An adequate qualitative and quantitative replacement of nutritional substrates are of utmost importance to facilitate proper tissue healing and recovery and maintenance of organ function after surgery.The present manuscript has been planned to put the most recent research of the Milano-Bicocca University surgical working group in the context of a more personalized nutritional therapy and metabolic care for surgical patients. Particular prominence has been given to major pancreatic resections because these surgeries are among the most complex and challenging operations for the degree of parenchyma resection and tissue dissection, the consequent overall injury, and the fairly high rate of major complications resulting in a catabolic response.Anthropometric parameters and particularly sarcopenia, visceral obesity – and their relative proportion -, are strongly associated with poor outcome after pancreatic surgery. Adequate perioperative nutritional therapy is of utmost importance in affecting morbidity. Long-term nutritional and metabolic sequelae, caused by exocrine pancreatic insufficiency, need to be promptly recognized and treated with an adequate enzyme supplementation.There is strong evidence sustaining the necessity of proper perioperative metabolic and nutritional care into the management of patients undergoing major pancreatic surgery.
Keywords	complications (disease) ; diet therapy ; homeostasis ; morbidity ; obesity ; patients ; resection ; sarcopenia
Language	English
Dates of publication	2019-1025
Publishing place	Elsevier Ltd
Document type	Article
Note	Pre-press version
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2019.10.029
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Preoperative carbohydrates: what is new?

Gianotti, Luca / Sandini, Marta / Hackert, Thilo

Current opinion in clinical nutrition and metabolic care

2020 Volume 23, Issue 4, Page(s) 262–270

Abstract: Purpose of review: The aim of this review is to give an overview of recently published articles covering preoperative carbohydrate loading in surgical patients.: Recent findings: Between January 1, 2017, and December 31, 2019, 26 publications ... ...

Abstract	Purpose of review: The aim of this review is to give an overview of recently published articles covering preoperative carbohydrate loading in surgical patients. Recent findings: Between January 1, 2017, and December 31, 2019, 26 publications addressing the effect of carbohydrate load were retrieved through a systematic search. Seventeen were randomized clinical trials, three prospective observational studies and six retrospective series with case-control comparison. Most of the studies were underpowered, addressed surrogate endpoints, and variability among dose and timing of carbohydrate (CHO) treatment was high. The most recent literature endorses preoperative carbohydrate loading up to 2 h before operations as a safe treatment. The new evidence confirm that this strategy is effective in reducing perioperative insulin resistance and the proportion of hyperglycemia episodes, and improving patient well-being and comfort but without affecting surgery-related morbidity. Summary: Further properly designed randomized clinical trials, addressing more clinically relevant endpoints such as length of hospitalization and morbidity rate, are warrant.
MeSH term(s)	Biomarkers/blood ; Blood Glucose/metabolism ; Diet, Carbohydrate Loading/methods ; Dietary Carbohydrates/administration & dosage ; Humans ; Hyperglycemia/prevention & control ; Insulin Resistance ; Observational Studies as Topic ; Postoperative Complications/prevention & control ; Preoperative Care/methods ; Prospective Studies ; Randomized Controlled Trials as Topic ; Retrospective Studies
Chemical Substances	Biomarkers ; Blood Glucose ; Dietary Carbohydrates
Language	English
Publishing date	2020-01-21
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1460178-3
ISSN	1473-6519 ; 1363-1950
ISSN (online)	1473-6519
ISSN	1363-1950
DOI	10.1097/MCO.0000000000000661
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