The influence of nutritional status on the incidence of postoperative complications in patients following distal pancreatectomy

Abstract

Introduction: Malnutrition is a common problem in hospitalised patients. The immunological, inflammatory, and nutritional status of patients significantly influences the postoperative outcome. Aim: To assess and analyse the influence of the nutritional status on postoperative complications in patients following distal pancreatectomy. Material and methods: The analysis included 50 patients operated in a large centre of gastrointestinal surgery. The clinicopathological parameters were analysed, and the nutritional status was assessed. The prognostic nutritional index (PNI) was calculated as 10 × serum albumin (g/dl) + 0.005 × total lymphocyte count (per mm 3). The immunological parameters, neutrophil/ lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and lymphocyte/monocyte ratio (LMR) were calculated. Patients were divided into two groups according to the presence of early postoperative complications: those without postoperative complications and those with postoperative complications. Results: Early postoperative complications were observed in 15 (30.0%) patients undergoing distal pancreatectomy. Postoperative pancreatic fistula (POPF) was the most frequent complication noted in 11 (22%) patients. Significantly higher Nutritional Risk Screening (NRS) 2002 (p = 0.005) and lower PNI (median value: 56 vs. 41, p = 0.0003) were noted in patients with postoperative complications. In laboratory results, the significantly lower total lymphocyte count (median value: 2.4 vs. 1.4 per mm 3 , p = 0.01) and serum level of albumin (median value: 4.7 vs. 3.3 g/dl, p = 0.0003) were noted in the complications group. Conclusions: Nutritional status significantly influences the incidence of postoperative complications in patients following distal pancreatectomy. Assessment of nutritional status using PNI calculation should be the standard management of patients before surgical treatment.

Prognostic Nutritional Index Predicts Toxicity in Head and Neck Cancer Patients Treated with Definitive Radiotherapy in Association with Chemotherapy

“…A low PNI has recently been recognized to predict iatrogenic toxicity and complication in oncologic patients undergoing surgery or chemotherapy [ 38 , 55 ]. Low PNI has been associated with severe acute adverse events (i.e., toxicity of grade ≥ 3) of any type in HNC patients treated with radical or adjuvant radiotherapy [ 39 ], without distinction of single toxicity type.…”

Associations between Nutritional and Immune Status and Clinicopathologic Factors in Patients with Pancreatic Cancer: A Comprehensive Analysis

“…It has been reported that impaired NS is associated with higher perioperative morbidity following pancreatectomy and lower survival in PC patients. It has been reported that the poor NS was associated with a higher number of infections, delayed wound healing, impaired blood clotting, and vessel wall fragility and generally a higher number of postoperative complications following pancreatectomy [4][5][6]. It is also known that malnutrition is associated with deteriorated humoral and cellular immune response [6].…”

“…It has been reported that the poor NS was associated with a higher number of infections, delayed wound healing, impaired blood clotting, and vessel wall fragility and generally a higher number of postoperative complications following pancreatectomy [4][5][6]. It is also known that malnutrition is associated with deteriorated humoral and cellular immune response [6]. Systemic inflammation is considered a significant indicator of a poor prognosis in PC patients [3,[6][7][8][9].…”

“…It is also known that malnutrition is associated with deteriorated humoral and cellular immune response [6]. Systemic inflammation is considered a significant indicator of a poor prognosis in PC patients [3,[6][7][8][9].…”

Trends in the utilization of neoadjuvant therapy for pancreatic ductal adenocarcinoma

“…The neoadjuvant time period thus serves as an ideal time for targeted interventions to improve patient comorbidities, nutritional indices, and functional condition before major oncologic surgery (i.e., prehabilitation). Patients with a high frailty index or poor nutritional status are also at risk for higher rates of postoperative morbidity and mortality 23,24 . Patients with potentially resectable PDAC who underwent prehabilitation with more than 60 min of physical activity a week experienced an increase in health‐related quality of life and physical function 25 .…”