Factors predicting postoperative complications in whipple procedure - single centre experience from a tertiary care centre

Abstract

Introduction: Sarcopenia is closely associated with morbidity after pancreatic surgery. However, little is known about the value of preoperative therapy in the management of sarcopenia. Hence, we investigated the impact of preoperative nutritional support on patients with skeletal muscle (SM) loss undergoing pancreatoduodenectomy. Methods: A retrospective analysis of 101 patients who underwent pancreatoduodenectomy was performed. SM loss was defined using the SM index (cut-off level: 42 cm2/m2 in men and 38 cm2/m2 in women). Preoperative nutritional support, including branched-chain amino acids (BCAAs), was administered in 33 patients. The neutrophil-tolymphocyte ratio (NLR), Prognostic Nutritional Index (PNI), and modified Glasgow Prognostic Score (mGPS) values were calculated during the first visit and just before surgery. Results: SM loss was present in 65 of 101 patients (64%) and was significantly correlated with female sex, older age, lower body mass index (BMI), and low PNI. Preoperative nutritional support prevented the decrease in the albumin levels and in the PNI values for the patients with SM loss. The NLR significantly improved in the patients with SM loss who received nutritional support. In the patients with SM loss, the lack of nutritional support was an independent risk factor for postoperative pancreatic fistula. Conclusion: Decreased incidence of pancreatic fistula could be achieved through preoperative nutritional support for patients with SM loss undergoing pancreatoduodenectomy. The assessment for SM loss and the administration of nutritional support may improve the surgical outcomes of pancreatoduodenectomy.