Clinical impact of perioperative malnutrition in patients with pancreatic cancer

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  • 膵臓がん周術期の栄養不良例の臨床的特徴

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Abstract

<p>Aim: This study sought to clarify the clinical impact of perioperative malnutrition in patients with pancreatic cancer (PC). </p><p>Patients and Methods: A total of 255 eligible patients with PC who underwent resection at our hospital between 2007 and 2014 were evaluated in this single institutional retrospective observational study. Nutritional status before surgery and at discharge was evaluated using the Controlling Nutritional Status (CONUT) score; clinical and therapy-related factors as well as survival were compared between the groups according to perioperative nutritional status. </p><p>Results: Malnutrition was observed in 57% of all patients at discharge, which marked a significant increase (42% higher) than that before surgery (15%). Preoperative malnutrition was observed slightly more in older and male patients. There were no significant differences in tumor size or resectability, duration of hospital stay, receiving postoperative adjuvant therapy, and survival rate between patients with and without preoperative malnutrition. In contrast, patients with malnutrition at discharge demonstrated significantly longer operative duration (p<0.0001), more blood loss (p<0.0001), more frequent pancreatic head resection (p<0.0001) or combined vascular resection (p<0.0001), longer hospital stay (p<0.0001), and significantly shorter survival rate (p=0.041) compared with those without malnutrition at discharge. Multivariate regression analysis revealed significant associations of low serum cholesterol level (p=0.012), borderline resectability (p=0.035), long operative duration (p=0.021), excessive blood loss (p=0.049), and long hospital stay (p=0.0024) with malnutrition at discharge. </p><p>Conclusions: Prognosis after resection for PC was influenced more by nutritional status (malnutrition) at discharge than by preoperative malnutrition. Low serum cholesterol, borderline resectablility, long operative duration, excessive blood loss, and/or long hospital stay were significant risk factors for malnutrition at discharge, and nutritional assessment and intervention after discharge are important to further improve survival.</p>

Journal

  • Online Journal of JSPEN

    Online Journal of JSPEN 1 (4), 216-226, 2019

    Japanese Society for Clinical Nutrition and Metabolism

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