Okazoe Yuki, Yanagimoto Hiroaki, Tsugawa Daisuke, Akita Masayuki, Mizumoto Takuya, Yoshida Toshihiko, So Shinichi, Ishida Jun, Urade Takeshi, Nanno Yoshihide, Fukushima Kenji, Gon Hidetoshi, Komatsu Shohei, Asari Sadaki, Toyama Hirochika, Kido Masahiro, Fukumoto Takumi
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan.
Surg Today. 2025 May 27. doi: 10.1007/s00595-025-03051-9.
The Global Leadership Initiative on Malnutrition (GLIM) criteria, proposed in 2018, provide universal diagnostic standards for malnutrition, a known risk factor for postoperative complications in patients with various cancers. However, its impact on surgery for biliary tract cancer (BTC) remains unclear. This study evaluates the relationship between GLIM-defined malnutrition and postoperative complications after resection for BTC.
The subjects of this retrospective study were patients who underwent pancreaticoduodenectomy or major hepatectomy with extrahepatic bile duct resection for BTC between January, 2013 and December, 2021. The comprehensive complication index (CCI), an indicator of postoperative complications, was calculated based on the total number and severity of postoperative complications.
GLIM-defined malnutrition was diagnosed in143 (71.1%) of the total 201 patients. The median CCI was significantly higher in the GLIM-defined malnutrition group than in the non-malnutrition group (37.2 vs. 28.3; P < 0.001). Multivariate logistic regression analysis revealed that GLIM-defined malnutrition (odds ratio 2.87 [95% confidence interval 1.38-5.96], P = 0.005) and intraoperative blood loss > 1,000 mL (odds ratio 3.77 [95% confidence interval 1.06-13.47], P = 0.041) were independent predictors of high morbidity (CCI ≥ 37.1).
Preoperative GLIM-defined malnutrition was closely associated with increased postoperative complications in patients who underwent resection for BTC.
2018年提出的全球营养不良领导倡议（GLIM）标准为营养不良提供了通用诊断标准，营养不良是各类癌症患者术后并发症的已知危险因素。然而，其对胆管癌（BTC）手术的影响仍不明确。本研究评估了GLIM定义的营养不良与BTC切除术后并发症之间的关系。
本回顾性研究的对象为2013年1月至2021年12月期间因BTC接受胰十二指肠切除术或肝外胆管切除的大肝切除术的患者。基于术后并发症的总数和严重程度计算综合并发症指数（CCI），作为术后并发症的指标。
201例患者中，143例（71.1%）被诊断为GLIM定义的营养不良。GLIM定义的营养不良组的中位CCI显著高于非营养不良组（37.2对28.3；P < 0.001）。多因素逻辑回归分析显示，GLIM定义的营养不良（优势比2.87 [95%置信区间1.38 - 5.96]，P = 0.005）和术中失血量>1000 mL（优势比3.77 [95%置信区间1.06 - 13.47]，P = 0.041）是高发病率（CCI≥37.1）的独立预测因素。
术前GLIM定义的营养不良与接受BTC切除术的患者术后并发症增加密切相关。
