Department of Medical, Surgical, and Neurologic Sciences, University of Siena, Siena, Italy.
Surgical Oncology Unit, Policlinico Le Scotte, Siena, Italy.
Ann Surg Oncol. 2024 Jun;31(6):3995-4004. doi: 10.1245/s10434-024-15143-w. Epub 2024 Mar 23.
Preoperative nutritional status and body structure affect short-term prognosis in patients undergoing major oncologic surgery. Bioimpedance vectorial analysis (BIVA) is a reliable tool to assess body composition. Low BIVA-derived phase angle (PA) indicates a decline of cell membrane integrity and function. The aim was to study the association between perioperative PA variations and postoperative morbidity following major oncologic upper-GI surgery.
Between 2019 and 2022 we prospectively performed BIVA in patients undergoing surgical resection for pancreatic, hepatic, and gastric malignancies on the day before surgery and on postoperative day (POD) 1. Malnutrition was defined as per the Global Leadership Initiative on Malnutrition criteria. The PA variation (ΔPA) between POD1 and preoperatively was considered as a marker for morbidity. Uni and multivariable logistic regression models were applied.
Overall, 542 patients with a mean age of 64.6 years were analyzed, 279 (51.5%) underwent pancreatic, 201 (37.1%) underwent hepatobiliary, and 62 (11.4%) underwent gastric resections. The prevalence of preoperative malnutrition was 16.6%. The overall morbidity rate was 53.3%, 59% in those with ΔPA < -0.5 versus 46% when ΔPA ≥ -0.5. Age [odds ratio (OR) 1.11; 95% confidence interval (CI) (1.00; 1.22)], pancreatic resections [OR 2.27; 95% CI (1.24; 4.18)], estimated blood loss (OR 1.20; 95% CI (1.03; 1.39)], malnutrition [OR 1.77; 95% CI (1.27; 2.45)], and ΔPA [OR 1.59; 95% CI (1.54; 1.65)] were independently associated with postoperative complications in the multivariate analysis.
Patients with preoperative malnutrition were significantly more likely to develop postoperative morbidity. Moreover, a decrease in PA on POD1 was independently associated with a 13% increase in the absolute risk of complications. Whether proactive interventions may reduce the downward shift of PA and the complication rate need further investigation.
术前营养状况和身体结构会影响接受重大肿瘤外科手术的患者的短期预后。生物电阻抗矢量分析（BIVA）是评估身体成分的可靠工具。低 BIVA 衍生的相位角（PA）表明细胞膜完整性和功能下降。目的是研究重大上消化道肿瘤手术后围手术期 PA 变化与术后发病率之间的关系。
2019 年至 2022 年，我们前瞻性地对接受胰腺、肝脏和胃恶性肿瘤手术的患者进行了术前和术后第 1 天的 BIVA。根据全球营养不良倡议标准定义营养不良。将术后第 1 天与术前的 PA 变化（ΔPA）视为发病率的标志物。应用单变量和多变量逻辑回归模型。
共分析了 542 例平均年龄为 64.6 岁的患者，其中 279 例（51.5%）接受了胰腺切除术，201 例（37.1%）接受了肝胆切除术，62 例（11.4%）接受了胃切除术。术前营养不良的患病率为 16.6%。总发病率为 53.3%，ΔPA< -0.5 者为 59%，ΔPA≥ -0.5 者为 46%。年龄[比值比（OR）1.11；95%置信区间（CI）（1.00；1.22)]、胰腺切除术[OR 2.27；95%CI（1.24；4.18)]、估计出血量[OR 1.20；95%CI（1.03；1.39)]、营养不良[OR 1.77；95%CI（1.27；2.45)]和ΔPA[OR 1.59；95%CI（1.54；1.65)]在多变量分析中与术后并发症独立相关。
术前营养不良的患者发生术后并发症的可能性明显更高。此外，术后第 1 天 PA 的下降与并发症绝对风险增加 13%独立相关。是否主动干预可能降低 PA 的下降趋势和并发症发生率需要进一步研究。
