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. 2021 Nov 30:11:748341.
doi: 10.3389/fonc.2021.748341. eCollection 2021.

The Impact of Preoperative and Postoperative Malnutrition on Outcomes for Ampullary Carcinoma After Pancreaticoduodenectomy

Jikuan Jin  1 , Guangbing Xiong  1 , Xiaoxiang Wang  1 , Feng Peng  1 , Feng Zhu  1 , Min Wang  1 , Renyi Qin  1
Affiliations

The Impact of Preoperative and Postoperative Malnutrition on Outcomes for Ampullary Carcinoma After Pancreaticoduodenectomy

Jikuan Jin et al. Front Oncol. .

Abstract

Purpose: The aim of this study was to investigate the effect of preoperative and postoperative malnutrition on postoperative short- and long-term outcomes for ampullary carcinoma after pancreatoduodenectomy (PD).

Methods: Data were collected retrospectively from 511 patients with ampullary carcinoma who underwent PD between June 2012 and June 2019. Nutritional status before and at 3, 6, and 12 months after operation was assessed by the scored Patient-Generated Subjective Global Assessment (PG-SGA). The patients were classified into well-nourished, moderately malnourished, and severely malnourished group according to the PG-SGA score. Propensity score matching (PSM) was performed to adjust baseline characteristics between preoperative group A (well-nourished and moderately malnourished group) and group B (severely malnourished group). After PSM, clinicopathological variables and postoperative complications were compared between the two groups. Univariate and multivariate Cox analysis was also conducted to investigate the prognostic factors of overall survival of patients with ampullary carcinoma who underwent PD.

Results: Preoperatively, 122 (23.9%) patients were classified into well-nourished group, 189 (37.0%) into moderately malnourished group, and 200 (39.1%) into severely malnourished group. After PSM analysis, the incidence of overall postoperative complications was higher in group B than that in group A (50.5% vs. 32.5%, p < 0.001). Multivariate Cox proportional hazards regression model showed that severe malnutrition (PG-SGA score >9 scores) before operation [hazard ratio (HR) = 1.508; 95% CI, 1.103-2.061; p = 0.01] and at 6 months (HR = 4.148; 95% CI, 2.523-6.820; p < 0.001) and 12 months (HR = 5.272; 95% CI, 3.630-7.656; p < 0.001) after operation was an independent prognostic factor of patients who underwent PD for ampullary carcinoma.

Conclusions: Severe malnutrition before and at 6 and 12 months after operation significantly affects the long-term survival of patients with ampullary carcinoma who underwent PD. Additionally, the preoperative malnutrition was closely related to postoperative complications.

Keywords: Patient-Generated Subjective Global Assessment; ampullary carcinoma; malnutrition; pancreatoduodenectomy; postoperative outcomes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of before surgery and at 3, 6, and 12 months after pancreatoduodenectomy.
Figure 2
Figure 2
Changes in patients number in PG-SGA groups over time from before to 3, 6, and 12 months after pancreatoduodenectomy. A total of 122, 155, 199, and 245 patients were classified into well-nourished group (0–3 scores) before surgery and at 3, 6, and 12 months after operation, respectively; 189, 265, 207, and 78 patients were classified into moderately malnourished group (4–8 scores) before surgery and at 3, 6, and 12 months after operation, respectively; and 200, 67, 68, 116 patients were classified into severely malnourished group (>9 scores) before surgery and at 3, 6, and 12 months after operation, respectively.
Figure 3
Figure 3
Overall survival curves for patients in the well-nourished group, moderately malnourished group, and severely malnourished group before and at 3, 6, and 12 months after pancreatoduodenectomy. (A–D) Significant overall survival difference were observed among the three groups (p < 0.001).
See this image and copyright information in PMC

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