Department of Gastroenterology & Pancreatic Surgery, Zhejiang Province People's Hospital, Hangzhou, 310000, Zhejiang, People's Republic of China.
Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Provincial People's Hospital), Hangzhou, 310000, Zhejiang, People's Republic of China.
Sci Rep. 2024 Nov 28;14(1):29549. doi: 10.1038/s41598-024-81016-7.
Minimally invasive pancreaticoduodenectomy (MIPD) has been routinely performed in major centers, and its feasibility and efficacy in tumor treatment have been highly recognized. Malnutrition has been associated with higher rates of morbidity, and increased mortality in surgical patients. The effect of the nutritional status on MIPD outcomes still remains unclear and controversial. The clinical data of 207 consecutive patients who had MIPD between June 2017 and December 2022 were retrospectively analyzed. A multidimensional nutrition assessment was performed before surgery. Multivariable analysis and propensity score matching (PSM) was performed to identify the association of preoperative nutritional status on postoperative short-term prognosis(Morbidity-Mortality, Clavien-Dindo classification ≥ IIIa, postoperative pancreatic fistulas and biliary fistula). In the multivariable analysis, sarcopenia (OR 9.74, 95% CI 3.34-43.03) was associated with postoperative morbidity and sarcopenia (OR 6.74, 95% CI 2.24-30.24) was associated with major complications. In the cohort after PSM, sarcopenia remained independently associated with morbidity (OR 12.44, 95% CI 3.72- 59.16) and major complications (OR 8.14, 95% CI 2.13- 43.83). Sarcopenia before MIPD has an impact on postoperative outcomes. Nutritional status assessment, especially sarcopenia, should be part of the routine preoperative procedures to provide early and appropriate nutritional support for MIPD patients.
微创胰十二指肠切除术（MIPD）已在各大中心常规开展，其在肿瘤治疗中的可行性和疗效得到了高度认可。营养不良与手术患者更高的发病率和死亡率有关。营养状况对 MIPD 结果的影响尚不清楚且存在争议。回顾性分析了 207 例 2017 年 6 月至 2022 年 12 月期间接受 MIPD 的连续患者的临床资料。术前进行了多维营养评估。采用多变量分析和倾向评分匹配（PSM）来确定术前营养状况与术后短期预后（发病率-死亡率、Clavien-Dindo 分级≥IIIa、术后胰瘘和胆瘘）的关系。多变量分析中，肌少症（OR 9.74，95%CI 3.34-43.03）与术后发病率相关，肌少症（OR 6.74，95%CI 2.24-30.24）与主要并发症相关。在 PSM 后的队列中，肌少症仍然与发病率（OR 12.44，95%CI 3.72-59.16）和主要并发症（OR 8.14，95%CI 2.13-43.83）独立相关。MIPD 前的肌少症对术后结果有影响。营养状况评估，尤其是肌少症，应成为常规术前程序的一部分，为 MIPD 患者提供早期和适当的营养支持。
