Division of Metabolic Diseases and Clinical Nutrition, Department of Specialistic Medicines, University Hospital of Modena, 41100 Modena, Italy.
Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, Policlinico Modena Hospital, 41125 Modena, Italy.
Nutrients. 2023 Apr 19;15(8):1958. doi: 10.3390/nu15081958.
Pancreatic surgery has been associated with important postoperative morbidity, mortality and prolonged length of hospital stay. In pancreatic surgery, the effect of poor preoperative nutritional status and muscle wasting on postsurgery clinical outcomes still remains unclear and controversial.
A total of 103 consecutive patients with histologically proven carcinoma undergoing elective pancreatic surgery from June 2015 through to July 2020 were included and retrospectively studied. A multidimensional nutritional assessment was performed before elective surgery as required by the local clinical pathway. Clinical and nutritional data were collected in a medical database at diagnosis and after surgery.
In the multivariable analysis, body mass index (OR 1.25, 95% CI 1.04-1.59, = 0.039) and weight loss (OR 1.16, 95% CI 1.06-1.29, = 0.004) were associated with Clavien score I-II; weight loss (OR 1.13, 95% CI 1.02-1.27, = 0.027) affected postsurgery morbidity/mortality, and reduced muscle mass was identified as an independent, prognostic factor for postsurgery digestive hemorrhages (OR 0.10, 95% CI 0.01 0.72, = 0.03) and Clavien score I-II (OR 7.43, 95% CI 1.53-44.88, = 0.018). No association was identified between nutritional status parameters before surgery and length of hospital stay, 30 days reintervention, 30 days readmission, pancreatic fistula, biliary fistula, Clavien score III-IV, Clavien score V and delayed gastric emptying.
An impaired nutritional status before pancreatic surgery affects many postoperative outcomes. Assessment of nutritional status should be part of routine preoperative procedures in order to achieve early and appropriate nutritional support in pancreatic cancer patients. Further studies are needed to better understand the effect of preoperative nutritional therapy on short-term clinical outcomes in patients undergoing pancreatic elective surgery.
胰腺手术与重要的术后发病率、死亡率和住院时间延长有关。在胰腺手术中，术前营养状况不佳和肌肉减少对术后临床结局的影响仍不清楚且存在争议。
回顾性分析 2015 年 6 月至 2020 年 7 月期间连续 103 例经组织学证实的腺癌患者行择期胰腺手术的资料。根据当地临床路径的要求，在择期手术前进行多维营养评估。在诊断和手术后，将临床和营养数据收集在一个医学数据库中。
多变量分析显示，体质指数（OR 1.25，95%CI 1.04-1.59， = 0.039）和体重减轻（OR 1.16，95%CI 1.06-1.29， = 0.004）与 Clavien 评分 I-II 相关；体重减轻（OR 1.13，95%CI 1.02-1.27， = 0.027）影响术后发病率/死亡率，并且肌肉减少被确定为术后消化出血（OR 0.10，95%CI 0.01-0.72， = 0.03）和 Clavien 评分 I-II（OR 7.43，95%CI 1.53-44.88， = 0.018）的独立预后因素。术前营养状况参数与住院时间、30 天再干预、30 天再入院、胰瘘、胆瘘、Clavien 评分 III-IV、Clavien 评分 V 和胃排空延迟之间无相关性。
胰腺手术前的营养状况受损会影响许多术后结果。在胰腺癌患者中，应将营养状况评估作为常规术前程序的一部分，以便尽早进行适当的营养支持。需要进一步研究以更好地了解术前营养治疗对接受胰腺择期手术患者短期临床结局的影响。
